Atomoxetine (brand name Strattera)
A non‑stimulant medication used primarily to treat attention‑deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. It’s the first FDA‑approved medication that doesn’t contain amphetamine or methylphenidate.
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How it works
- Mechanism: Atomoxetine selectively blocks the reuptake of norepinephrine (and to a lesser extent dopamine) in the brain, increasing the amount of these neurotransmitters available for signaling.
- Effect on ADHD: By boosting norepinephrine levels, it improves attention, focus, and impulse control.
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Approved uses
| Population | Typical dose range | Notes |
|------------|-------------------|-------|
| Children (6–17 yrs) | 0.5 mg/kg/day → 1.5 mg/kg/day | Usually 2× daily dosing, but some start with a single dose. |
| Adults (≥18 yrs) | 18 mg/day → 50 mg/day | Often starts low (18 mg) and increased by 18 mg increments every 1–2 weeks. |
| Adults with ADHD & anxiety | Same adult dosing | Atomoxetine can help with anxiety symptoms in some people, but it’s not first‑line for anxiety disorders. |
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How to take it
- Schedule: Take with or without food. If you miss a dose, take it as soon as you remember, but skip it if it’s almost time for the next dose.
- Consistency: Regular daily use is needed; it usually takes 4–6 weeks to feel the full benefit.
- Titration: Your doctor will titrate the dose based on response and tolerability.
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Common side effects
- Digestive: Nausea, stomach pain, decreased appetite, vomiting.
- Central: Dizziness, sleepiness, mood changes.
- Cardiovascular: Increased heart rate or blood pressure (rare).
- Others: Dry mouth, headache, constipation, irritability.
> Most side effects diminish after a few weeks. If any persist or worsen, notify your clinician.
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Serious concerns & monitoring
| Issue | What to watch for | Why it matters |
|-------|-------------------|----------------|
| Suicidality | Thoughts of self-harm or suicide, especially in the first 12 weeks | Studies show a small increased risk; regular mental‑health check‑ins are recommended. |
| Cardiovascular | Palpitations, chest pain, high blood pressure | Atomoxetine can raise heart rate/BP; avoid in patients with uncontrolled heart disease. |
| Drug interactions | SSRIs, SNRIs, MAO inhibitors, CYP2D6 inhibitors | These can increase atomoxetine levels or cause serotonin syndrome. |
| Pregnancy/Breastfeeding | Limited data | Generally not recommended in pregnancy; breastfeeding is discouraged until more safety data are available. |
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Contraindications & cautions
- Hypersensitivity to atomoxetine or any ingredient.
- Use with MAO inhibitors: Not allowed; must wait 14 days after stopping MAO inhibitors.
- Severe cardiovascular disease: Evaluate risk/benefit.
- High blood pressure: Monitor BP regularly.
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Drug interactions (non‑exhaustive)
- SSRIs/SNRIs (e.g., fluoxetine, sertraline) – may increase atomoxetine levels.
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) – increase exposure.
- Stimulants (e.g., methylphenidate) – additive cardiovascular effects.
- Alcohol – may heighten side effects; use caution.
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Practical tips
- Start slow – begin with the lowest dose; let the body adjust.
- Monitor appetite – a common early side effect; consider nutrient‑dense meals.
- Watch mood – if you notice worsening anxiety, irritability, or thoughts of self-harm, contact your provider promptly.
- Keep a medication diary – track doses, side effects, and symptom changes; this helps the clinician fine‑tune therapy.
- Avoid abrupt discontinuation – it can cause rebound ADHD symptoms or withdrawal‑like effects.
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Bottom line
Atomoxetine is a useful, non‑stimulant option for ADHD, especially for patients who cannot tolerate stimulants or have co‑existing anxiety. It requires a gradual dose increase, regular follow‑up for side effects and mental‑health monitoring, and attention to drug interactions and cardiovascular risk. If you’re considering atomoxetine, discuss your medical history, other meds, and goals with your doctor to determine the best plan.