Responding to accidental atomoxetine ingestion - Veterinary Medicine
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Responding to accidental atomoxetine ingestion
At fairly low dosages, atomoxetine—a drug in human medicine to treat ADHD—can be toxic in dogs and cats. Medical management of this toxicosis varies by species.



Of the more than 700 calls received from 2003 to 2010, 59 were single-agent exposures that had been assessed as having clinical signs and exposure histories that were highly consistent with an atomoxetine exposure. Of these cases, 38 were canine exposures and 21 were feline exposures (ASPCA APCC Database, Urbana, Ill: Unpublished data, 2003-2011).

Clinical signs reported in dogs ingesting atomoxetine*
The most common clinical signs seen in dogs are listed in Table 1. Of the 38 canine cases, three (1.32 mg/kg dose exposure, 7.6 mg/kg dose exposure, one with unknown dose) had reported outcomes. Two of these dogs required treatment at a veterinary hospital, but all three made a full recovery.

Clinical signs reported in cats ingesting atomoxetine*
Common clinical signs noted with feline exposures are listed in Table 2. There were two cases (22 mg/kg and 66.13 mg/kg dose exposures) with reported outcomes; both cats made a full recovery with medical treatment.

In both dogs and cats in the ASPCA APCC cases, mild clinical signs (lethargy, hypersalivation, vomiting) were noted at doses as low as 1 or 2 mg/kg. In many of the cases, hypersalivation and vomiting occurred within 15 minutes after the exposure, potentially indicating a taste reaction.

In dogs, more significant clinical signs (hyperactivity, agitation, tachycardia) were seen at doses > 2 mg/kg and generally developed one to three hours after exposure. Tremors occurred in a dog at 22 mg/kg. Doses ranged from 1.32 to 63 mg/kg in the canine cases. The duration of clinical signs ranged from minutes (vomiting) to several hours (six to 33.6 hours). Clinical signs would likely resolve within 24 to 48 hours with high-dose cases, but most of the cases reviewed did not report the outcome, and the durations of clinical signs were not available. No deaths were noted.

In the feline cases, doses ranged from 1.3 to 85.7 mg/kg. Significant clinical signs (tachycardia) were noted in cats at slightly lower doses (1.5 mg/kg) than were noted in dogs, but the onset of clinical signs was similar to that of dogs. In cats, tremors were noted at lower doses than were noted in dogs. Hindlimb tremors occurred in a cat at a dose of 9.7 mg/kg. Eighty percent of the cats with potential doses > 9.7 mg/kg developed trembling or tremors. The durations of clinical signs in the two cases that had outcomes were between 20 and 22.5 hours. No deaths were reported (ASPCA APCC Database, Urbana, Ill: Unpublished data, 2003-2011).


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