Atomoxetine
STRATTERA
What it isNorepinephrine-predominant reuptake inhibitor with weaker serotonin activity; nonstimulant treatment of ADHD.
Why this oneIt is neither controlled nor readily misused, making it useful when diversion or stimulant use is a concern.
What limits itOnset is slow; CYP2D6 inhibition or poor metabolism markedly raises exposure, and pediatric suicidality is boxed.
FDA-approved for
- ADHD (2002)
Off-label
- treatment-resistant depression
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| ADHD | Pediatric <70 kg | 0.5 mg/kg/day QD (AM) or ÷BID | 1.2 mg/kg/day | 1.4 mg/kg/day or 100 mg/day, whichever is less |
| ADHD | Pediatric ≥70 kg and adults | 40 mg/day QD (AM) or ÷BID | 80 mg/day | 100 mg/day |
Titration Minimum of 3 days between increases; 4 weeks if on a strong CYP2D6 inhibitor or a CYP2D6 poor metabolizer
Renal Undefined
Hepatic Moderate (Child-Pugh B): 50% of normal dose; severe (Child-Pugh C): 25% of normal dose; mild: no change
Instructions
- Take with or without food; swallow capsule whole, do not open
- No taper needed on discontinuation
- Screen for bipolar disorder/mania before starting
- At least 14 days between an MAOI and atomoxetine (both directions)
Contraindications
- MAOIs (concurrently or within 14 days)
- Narrow-angle glaucoma
- Pheochromocytoma or history of pheochromocytoma
- Severe cardiac or vascular disorders that would deteriorate with clinically important increases in BP or heart rate
Cautions
- Severe liver injury — discontinue and do not restart with jaundice/liver injury
- Serious cardiovascular reactions / sudden death; assess cardiac status first
- Increases in blood pressure and heart rate
- New psychotic or manic symptoms; screen for bipolar disorder
- Aggressive behavior or hostility
- Urinary retention/hesitancy
- Priapism
- Effect on growth in pediatric patients
- Suicidal thoughts and behaviors (boxed)
Adverse reactions
- Pediatric: nausea, vomiting, fatigue, decreased appetite, abdominal pain, somnolence
- Adults: dry mouth, nausea, decreased appetite, insomnia, constipation, dizziness, erectile dysfunction, urinary hesitation
Pregnancy Insufficient human data; some animal reproduction studies show adverse developmental outcomes; registry available
Lactation No human data; present in animal milk; weigh benefits and risks
⚠ BOXED WARNING
- Suicidal ideation in children and adolescents
Cost, est. cash$5–$150/month
Generic entry2010
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityBlood-pressure/heart-rate increases, rare hepatic injury and suicidal-thinking warning in younger patients.
Mechanism of action: Atomoxetine ballicule
Open Atomoxetine in the interactive console ↗
Memory aids: mascots and interaction avatars
highly sensitive CYP2D6 substrate → beach ball avatar used as the main mascot
