Childress Ann C
Center for Psychiatry and Behavioral Medicine, Inc., Las Vegas, NV, USA.
Ther Clin Risk Manag. 2015 Dec 23;12:27-39. doi: 10.2147/TCRM.S59270. eCollection 2016.
Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder beginning in childhood and often continuing into adulthood. A wealth of data shows that ADHD symptoms respond well to pharmacological treatment. Stimulant medications, including amphetamine and methylphenidate, are most commonly used to treat ADHD. However, with the approval of atomoxetine (Strattera(®), [ATX]) by the US Food and Drug Administration in late 2002, an effective non-stimulant option became available. The US Food and Drug Administration approved ATX for the treatment of ADHD in children, adolescents, and adults. Although the effect size of ATX is generally lower than that of stimulants, the American Academy of Child and Adolescent Psychiatry Practice Parameter for the treatment of ADHD lists ATX as a first-line treatment option. ATX is widely prescribed and accounted for 6% of the prescriptions of ADHD visits in the US in 2010. Numerous trials have found that ATX improves quality of life and emotional lability in addition to core ADHD symptoms. Although some improvement may be seen in a patient as early as one week after the initiation of treatment, ATX generally takes longer to have a full effect. The median time to response using 25% improvement in ADHD symptoms in pooled trials was 3.7 weeks. Data from these trials indicate that the probability of symptom improvement may continue to increase up to 52 weeks after treatment is initiated. ATX has been shown to be safe and effective in combination with stimulants. It has also been studied systematically in subjects with ADHD and comorbid oppositional defiant disorder, anxiety, depression, and substance use disorders. The mechanism of action of ATX, its efficacy, and adverse events reported in trials is reviewed.
注意缺陷多动障碍（ADHD）是一种常见的神经行为障碍，始于童年时期，且常常持续至成年。大量数据表明，ADHD症状对药物治疗反应良好。包括苯丙胺和哌甲酯在内的兴奋剂药物是治疗ADHD最常用的药物。然而，随着2002年末美国食品药品监督管理局批准托莫西汀（择思达（®），[ATX]），一种有效的非兴奋剂选择得以问世。美国食品药品监督管理局批准ATX用于治疗儿童、青少年及成人的ADHD。尽管ATX的效应量通常低于兴奋剂，但美国儿童与青少年精神病学会ADHD治疗实践参数将ATX列为一线治疗选择。ATX被广泛处方，在2010年占美国ADHD就诊处方的6%。众多试验发现，除了ADHD核心症状外，ATX还可改善生活质量和情绪不稳定。尽管患者在开始治疗后最早一周可能会出现一些改善，但ATX通常需要更长时间才能产生全面效果。在汇总试验中，以ADHD症状改善25%为标准，达到反应的中位时间为3.7周。这些试验的数据表明，症状改善的可能性在开始治疗后长达52周可能会持续增加。已证明ATX与兴奋剂联合使用安全有效。它也在患有ADHD合并对立违抗障碍、焦虑、抑郁和物质使用障碍的受试者中进行了系统研究。本文对ATX的作用机制、疗效以及试验中报告的不良事件进行了综述。
