Irish Journal of Medical Science

, Volume 182, Issue 3, pp 535–537 | Cite as

Atomoxetine-induced life-threatening long QT syndrome

  • M. ŠtuhecEmail author
  • V. Švab
Letter to the Editor

Attention deficit hyperactivity disorder (ADHD) is a developmental disorder with symptoms that may overlap and combine with those of learning disabilities, oppositional defiant disorder, and emotional problems, often due to post-traumatic stress following abuse [1]. The physiology of ADHD is an imbalance in catecholamine metabolism in the cerebral cortex, with inhibitory dopaminergic and noradrenergic activities decreased [2].

ADHD is treated with medication acting through dopaminergic and noradrenergic pathways, which are commonly stimulants. An alternative is atomoxetine (ATM), a selective norepinephrine reuptake inhibitor.

There are few reports of cardiovascular adverse effects of ATM. Due to the rare reports of serious cardiac events, ATM was labeled with cardiac risk warnings, but only when administered in excess of therapeutic doses, having generally no effect on cardiac repolarization, as measured by the QTc interval [3, 4]. ATM was not associated with a clinically significant...


Attention Deficit Hyperactivity Disorder Methylphenidate Attention Deficit Hyperactivity Disorder Zolpidem Atomoxetine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interests

The authors have no personal affiliations, financial relationship or any commercial interest to disclose relative to this article. The submitted report or any essential part of it is not published or simultaneously submitted to other publications prior to its appearance in this Journal.


  1. 1.
    Biederman J, Monuteaux MC, Kendrick E et al (2005) The CBCL as a screen for psychiatric comorbidity in paediatric patients with ADHD. Arch Dis Child 90:1010–1015PubMedCrossRefGoogle Scholar
  2. 2.
    Russell V, Allie S, Wiggins T (2000) Increased noradrenergic activity in prefrontal cortex slices of an animal model for attention-deficit hyperactivity disorder—the spontaneously hypertensive rat. Behav Brain Res 117:69–74PubMedCrossRefGoogle Scholar
  3. 3.
    Rajesh AS, Bates G, Wright JG (2006) Atomoxetine-induced electrocardiogram changes. Arch Dis Child 91:1023–1024PubMedCrossRefGoogle Scholar
  4. 4.
    Wernicke JF, Faries D, Girod D et al (2003) Cardiovascular effects of atomoxetine in children, adolescents and adults. Drug Saf 26:729–740PubMedCrossRefGoogle Scholar
  5. 5.
    Loghin C, Haber H, Beasley CM et al. (2012) Effects of atomoxetine on the qt interval in healthy CYP2D6 poor metabolizers. Br J Clin Pharmacol [Epub ahead of print]Google Scholar
  6. 6.
    Seifi A, Griffith H, Avestimehr S et al (2011) Atomoxetine-induced myocardial infarction. South Med J 104:153–154PubMedCrossRefGoogle Scholar
  7. 7.
    Li WY, Strang SE, Brown DR et al (2010) Atomoxetine changes rat’s HR response to stress from tachycardia to bradycardia via alterations in autonomic function. Auton Neurosci 154:48–53PubMedCrossRefGoogle Scholar
  8. 8.
    Drew BJ, Ackerman MJ, Funk M et al (2010) Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 55:934–947PubMedCrossRefGoogle Scholar
  9. 9.
    Graham J, Banaschewski T, Buitelaar J, European Guidelines Group et al (2011) European guidelines on managing adverse effects of medication for ADHD. Eur Child Adolesc Psychiatry 20:17–37PubMedCrossRefGoogle Scholar
  10. 10.
    Hennessy S, Schelleman H, Daniel GW et al (2010) Cardiovascular safety of ADHD medications: rationale for and design of an investigator-initiated observational study. Pharmacoepidemiol Drug Saf 19:934–941PubMedCrossRefGoogle Scholar
  11. 11.
    Roden DM (2006) Long QT syndrome: reduced repolarization reserve and the genetic link. J Intern Med 259:59–69PubMedCrossRefGoogle Scholar
  12. 12.
    Scherer D, Hassel D, Bloehs R et al (2009) Selective noradrenaline reuptake inhibitor atomoxetine directly blocks hERG currents. Br J Pharmacol 156:226–236PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2013

Authors and Affiliations

  1. 1.Psychiatric hospital OrmozOrmozSlovenia
  2. 2.Department of PsychiatryFaculty of Medicine, University of LjubljanaLjubljanaSlovenia

Personalised recommendations