atomoxetine
Brands: STRATTERA
Last reviewed 2026-02-12
Reviewed by PsychMed Editorial Team.
Quick answers
What is atomoxetine?
Atomoxetine (brand Strattera) is a non-stimulant medication for ADHD and works as a selective norepinephrine reuptake inhibitor. It is not a controlled substance and can be a useful option when stimulant misuse risk, tic disorders, or anxiety/insomnia concerns limit stimulants.
What is STRATTERA?
STRATTERA is a brand name for atomoxetine.
What is STRATTERA (atomoxetine) used for?
Label indications include: Attention-deficit/hyperactivity disorder (ADHD).
What drug class is STRATTERA (atomoxetine)?
Selective norepinephrine reuptake inhibitor (non-stimulant ADHD medication).
What strengths does STRATTERA (atomoxetine) come in?
Oral capsules (multiple strengths).
Snapshot
- Class: Adjunctive therapy
- Common US brands: STRATTERA
- Therapeutic drug monitoring not routinely recommended.
- Last reviewed: 2026-02-12
Clinical Highlights
Atomoxetine (brand Strattera) is a non-stimulant medication for ADHD and works as a selective norepinephrine reuptake inhibitor. It is not a controlled substance and can be a useful option when stimulant misuse risk, tic disorders, or anxiety/insomnia concerns limit stimulants. Onset is slower than stimulants (often 1–4+ weeks), so early expectation setting and early follow-up are typically helpful; benefit depends on consistent daily dosing rather than “as-needed” use.
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- In serious mental illness, atomoxetine may be preferred over stimulants when activation risk is high, but it can still worsen anxiety, agitation, and (rarely) mania; clinicians typically monitor closely if bipolar spectrum illness is present.
- Atomoxetine has a boxed warning for increased risk of suicidal ideation in children and adolescents; mood/suicide screening is typically included in pediatric use.
- The compare view, the atomoxetine evidence feed, and the atomoxetine print page can support counseling on titration, monitoring, and interaction risks.
Dosing & Formulations
Typically dosed once daily or divided twice daily; splitting can improve tolerability (GI upset, fatigue) in some patients. Adults often start at 40 mg/day and increase to a target of 80 mg/day after several days to weeks; maximum recommended dose is 100 mg/day (label).
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- CYP2D6 status matters. Poor metabolizers and strong CYP2D6 inhibitors can increase exposure and prolong effects; slower titration and close monitoring for fatigue, insomnia, and irritability after dose changes is common.
- Pediatric dosing is weight-based; titration is gradual, with appetite, sleep, and mood monitoring during dose changes.
- If there is no meaningful improvement after an adequate trial at a therapeutic dose (often 6–8 weeks), clinicians typically reassess diagnosis and comorbidities rather than escalating indefinitely.
Monitoring & Risks
Mood/suicide: monitoring focuses on new or worsening suicidal ideation in children and adolescents (boxed warning). Cardiovascular: blood pressure and heart rate are typically monitored; extra caution is used in patients with hypertension or tachyarrhythmias.
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- Hepatic: rare severe liver injury has been reported; evaluate persistent pruritus, dark urine, jaundice, or unexplained flu-like symptoms.
- Common tolerability issues include nausea, decreased appetite, fatigue, insomnia, and sexual side effects; dose timing and split dosing can help.
Drug Interactions
CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion) can increase exposure; lower starting doses and monitoring for side effects are often needed in these combinations. MAOI coadministration is contraindicated; an adequate washout is required.
Practice Notes
Atomoxetine is often chosen when stimulant diversion risk is high; it is typically paired with behavioral supports and clear functional targets for follow-up. If insomnia or fatigue dominates, dose timing (morning vs evening) and split dosing are common adjustment options before discontinuing.
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- If bipolar spectrum illness is present, activation is monitored during titration; mood elevation typically prompts stopping and reassessment.
References
- Strattera (atomoxetine) prescribing information — DailyMed (2026)
- Attention deficit hyperactivity disorder (NICE guideline NG87) — NICE (2018)
- Clinical Practice Guideline FOR THE Diagnosis, Evaluation, AND Treatment OF Attention Deficit/hyperactivity Disorder IN Children AND Adolescents — Pediatrics (2019)
- Comparative Efficacy AND Tolerability OF Medications FOR Adhd (systematic Review AND Network Meta Analysis) — Lancet Psychiatry (2018)