A 9-year-old boy is diagnosed with ADHD (combined presentation). His parents refuse stimulants. Which non-stimulant medication has FDA approval for ADHD as monotherapy?
- A Bupropion
- B Atomoxetine (Strattera) ✓
- C Clonidine IR
- D Venlafaxine
Explanation
Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that is FDA-approved as a non-stimulant monotherapy for ADHD in children (≥6 years), adolescents, and adults. It works by increasing norepinephrine in the prefrontal cortex. Unlike stimulants, it has no abuse potential and is preferred in patients with comorbid substance use history or tic disorders. Full effect may take 4–8 weeks. FDA black box warning: increased suicidal ideation in children and adolescents (monitoring required). Guanfacine ER and clonidine ER are also FDA-approved as adjuncts but are primarily used as add-ons. Bupropion has off-label use but no FDA approval for ADHD.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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