Atomoxetine (Strattera)

What it treats

Atomoxetine is approved by the U.S. Food and Drug Administration to treat attention-deficit hyperactivity disorder, or ADHD, in children, adolescents, and adults. It is the main non-stimulant option for ADHD.

Prescribers often consider atomoxetine when a stimulant is not a good fit, for example when stimulant side effects are hard to tolerate, when there are concerns about misuse, or when a person prefers a medication that is not a controlled substance. It can also be used alongside or instead of a stimulant depending on the situation.

How it works

Atomoxetine is a norepinephrine reuptake inhibitor. Nerve cells in the brain pass messages using chemical messengers, and norepinephrine is one of them, involved in attention and alertness. After a cell releases norepinephrine, it normally reabsorbs much of it, a process called reuptake. Atomoxetine slows that reabsorption, so more norepinephrine stays available between cells.

Unlike stimulant ADHD medications, atomoxetine is not a controlled substance and does not act mainly on dopamine. That difference in how it works is also why it does not produce the rapid, dose-by-dose effect that stimulants do.

What to expect

Common side effects

Most people get some side effects. The common ones include:

• Nausea.
• Reduced appetite.
• Dry mouth.
• Tiredness or drowsiness.
• Dizziness.
• Trouble sleeping.

Atomoxetine can also modestly raise heart rate and blood pressure. In adults, sexual side effects and some urinary symptoms, such as difficulty starting urination, can occur. Many of the milder early effects ease as the body adjusts. Taking the dose with food can help with nausea. If a side effect is severe, or it is not improving, that is a conversation to have with the prescriber rather than a reason to stop on your own.

Serious side effects and warnings

Serious problems are uncommon, but a few are worth knowing.

Boxed warning. Atomoxetine carries an FDA boxed warning about an increased risk of suicidal thoughts in children and adolescents, especially early in treatment. This does not mean the medication harms most people. It means the early period deserves close attention, and that any worsening of mood, agitation, or new thoughts of self-harm should prompt contact with the prescriber promptly.

• Liver injury. Rare cases of liver injury have been reported. Signs such as dark urine, yellowing of the skin or eyes, itching, pain in the upper right abdomen, or unexplained tiredness should be reported to a prescriber.
• Cardiovascular effects. Atomoxetine can modestly raise heart rate and blood pressure. It is used with caution in people who have heart conditions, and a prescriber may check heart rate and blood pressure during treatment.
• Slowed growth in children. In children, atomoxetine can slightly slow growth, so height and weight are monitored over time.

Sexual side effects

Sexual side effects can occur in adults taking atomoxetine. They can include lower sex drive or difficulty with arousal or orgasm. If that happens, it is worth raising with a prescriber rather than living with it, because there are usually options.

Weight, appetite, and sleep

Atomoxetine can reduce appetite, with modest effects on weight. In children, height and weight are tracked because growth can slow slightly. Appetite often steadies somewhat as the body adjusts.

Its effect on sleep goes both ways. It causes trouble sleeping for some people and drowsiness for others. Depending on which way it goes, a prescriber may suggest taking it in the morning or in the evening, and sometimes splitting it into two doses.

Starting and dosing basics

This section is general background, not a dosing instruction for any individual. The right dose is a decision for a prescriber.

Atomoxetine comes as capsules that are swallowed whole. They are not opened, chewed, or crushed. It is taken once a day, or split into two doses, depending on how a person responds and tolerates it. In children the dose is based on body weight. The prescriber usually starts low and increases gradually. It can be taken with or without food, though food can help with nausea.

Missed doses and interactions

If you miss a dose, the general guidance is to take it when you remember, unless it is almost time for the next dose. In that case, skip the missed dose and carry on. Don't take two doses to make up for one. Because atomoxetine works gradually rather than dose by dose, a single missed dose is not an emergency.

Several interactions matter. Atomoxetine must not be combined with MAOI antidepressants, and a gap is needed when switching between them. Some people break atomoxetine down slowly, which affects how the dose is set. Medicines that affect heart rate or blood pressure need attention, since atomoxetine can raise both. Give every prescriber and pharmacist a full list of your medications and supplements, including over-the-counter ones.

Stopping and tapering

Atomoxetine is not a controlled substance, and it does not cause dependence or a withdrawal syndrome. That makes it generally more straightforward to stop than a controlled medication. Even so, any change should be coordinated with a prescriber, both to confirm it is the right move and to plan what comes next if ADHD symptoms return.

Pregnancy and breastfeeding

This is an area where individual circumstances matter and the decision belongs with a clinician. There is limited information on atomoxetine in pregnancy and breastfeeding, and ADHD itself affects daily functioning. None of that adds up to one answer that fits everyone. Anyone who is pregnant, planning a pregnancy, or breastfeeding should talk it through with their prescriber so the specific risks and benefits can be weighed for their situation.

Cost and generic availability

Atomoxetine has been available as a generic for years and is inexpensive. Strattera is the brand name, and brand and generic contain the same active medication and work the same way. Most insurance plans cover the generic, and for people paying out of pocket, generic atomoxetine is a lower-cost option.

Common questions

How is atomoxetine different from a stimulant like Adderall? Atomoxetine is not a controlled substance and is not fast-acting. It acts mainly on norepinephrine rather than dopamine, and it builds its effect over weeks of daily use instead of working dose by dose.

How long until it works? It takes several weeks of regular daily use to reach its full effect. It is normal to feel little change in the first weeks, more like an antidepressant than a stimulant.

Is it a controlled substance? No. Unlike stimulant ADHD medications, atomoxetine is not a controlled substance.

Is it addictive? No. Atomoxetine does not cause dependence or a withdrawal syndrome.

Can it be taken as needed? No. Atomoxetine is a daily medication. It does not produce a same-day effect, so taking it only on certain days does not work the way it can for some stimulants.

Questions to ask your prescriber

• What are we hoping this treats, and how will we know it's working?
• How long should I wait before we judge whether it is helping?
• Which side effects should I expect early, and which ones should I call about?
• Should I take it in the morning or the evening?
• If it doesn't help enough, what are the next options?

Sources

This guide draws on current prescribing information and public health references. It is reviewed for clinical accuracy and updated as guidance changes.

• U.S. Food and Drug Administration. Atomoxetine (Strattera) prescribing information.
• MedlinePlus, U.S. National Library of Medicine. Atomoxetine.
• National Institute of Mental Health. Mental health medications.