A 9-year-old boy has ADHD predominantly inattentive presentation. He has a tic disorder and his parents are concerned about worsening tics. Among the following, the agent LEAST likely to worsen tics while effectively treating ADHD is:
- A Atomoxetine (a norepinephrine reuptake inhibitor) ✓
- B Methylphenidate at standard doses
- C Amphetamine salts (Adderall)
- D Dextroamphetamine
Correct answer: A. Atomoxetine (a norepinephrine reuptake inhibitor)
Explanation
Atomoxetine is a selective norepinephrine reuptake inhibitor (non-stimulant) approved for ADHD. Unlike stimulants (methylphenidate, amphetamines), which increase synaptic dopamine and can transiently exacerbate tics in susceptible individuals, atomoxetine does not significantly increase dopaminergic tone in the striatum and is the preferred choice when ADHD co-exists with a tic disorder. Guanfacine XR (alpha-2 agonist) is another non-stimulant option that additionally suppresses tics.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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