Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor (SNRI) approved for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents, and adults. Unlike many first-line ADHD treatments, it is not a controlled substance and does not act as a stimulant, offering a distinct pharmacological profile. Its mechanism focuses on increasing norepinephrine in the prefrontal cortex, which is crucial for attention, impulse control, and executive functioning. This makes it a valuable option for patients who cannot tolerate stimulants, have a history of substance use disorder, or require 24-hour symptom coverage.

Features

• Active ingredient: Atomoxetine hydrochloride
• Available in capsule formulations: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg
• Non-controlled substance classification (not a stimulant)
• Selective norepinephrine reuptake inhibitor (SNRI)
• Once or twice-daily dosing regimen
• Approved for use in patients aged 6 years and older
• Requires several weeks to achieve full therapeutic effect

Benefits

• Provides 24-hour symptom control due to its extended pharmacokinetic profile, reducing the need for midday dosing.
• Lowers the risk of abuse, dependence, and diversion compared to stimulant medications, making it suitable for patients with substance use concerns.
• Does not typically cause insomnia or appetite suppression to the same degree as stimulants, supporting better sleep and nutritional health.
• May improve both attention and emotional regulation, aiding in reduced impulsivity and better mood stability.
• Can be taken with or without food, offering flexibility in daily routine management.
• Avoids the rebound effects sometimes associated with short-acting stimulant formulations.

Common use

Strattera is indicated for the management of ADHD symptoms, including inattention, hyperactivity, and impulsivity, in pediatric patients (6 years and older) and adults. It is often prescribed when stimulant medications are ineffective, contraindicated, or not preferred by the patient or clinician. It may also be chosen for patients with comorbid anxiety or tic disorders, as it is less likely to exacerbate these conditions compared to stimulants. Clinical use is supported by improvements in structured rating scales and patient-reported outcomes related to focus, organizational skills, and behavioral control.

Dosage and direction

Dosing is weight-based for children and adolescents under 70 kg, starting at approximately 0.5 mg/kg/day, with increases after a minimum of 3 days to a target dose of 1.2 mg/kg/day, up to a maximum of 1.4 mg/kg/day or 100 mg/day, whichever is less. For patients over 70 kg and adults, the initial dose is 40 mg daily, increasing after a minimum of 3 days to a target maintenance dose of 80 mg daily, up to a maximum of 100 mg daily. It may be administered as a single daily dose or divided into two doses (morning and late afternoon/early evening) to improve tolerability. Capsules should be swallowed whole and not opened, chewed, or crushed. Regular monitoring by a healthcare provider is essential for dose titration and long-term management.

Precautions

Patients should be monitored for the emergence or worsening of aggression, hostility, or suicidal ideation, particularly at treatment initiation or dose changes. Liver function should be assessed periodically due to rare reports of severe liver injury. Use with caution in patients with cardiovascular conditions such as hypertension, tachycardia, or structural abnormalities; baseline and periodic cardiovascular evaluations are recommended. May cause orthostatic hypotension and syncope, especially during initial titration. Not recommended during pregnancy unless potential benefits outweigh risks. Patients should avoid activities requiring mental alertness, such as driving, until they know how Strattera affects them.

Contraindications

Hypersensitivity to atomoxetine or any component of the formulation. Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy, due to risk of serotonin syndrome or hypertensive crisis. Narrow-angle glaucoma. Severe cardiovascular disorders that could be exacerbated by increases in heart rate or blood pressure. Pheochromocytoma or history of pheochromocytoma.

Possible side effect

Common side effects include nausea, vomiting, dry mouth, decreased appetite, fatigue, dizziness, and mood swings. Less frequently, patients may experience insomnia, constipation, dyspepsia, hot flashes, or erectile dysfunction. Important but rare adverse effects include severe liver injury, priapism, angioedema, urticaria, and Raynaud’s phenomenon. Suicidal ideation has been reported in children and adolescents. Most side effects are dose-dependent and may diminish over time; consult a healthcare provider if persistent or severe.

Drug interaction

MAOIs: Contraindicated due to risk of hypertensive crisis. CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine): May increase atomoxetine levels; dose adjustment may be necessary. Albuterol or other beta2-agonists: May potentiate cardiovascular effects. Antihypertensives: Atomoxetine may reduce their efficacy. Drugs that affect norepinephrine: Additive effects may increase risk of adverse events. Avoid with other SNRIs or drugs that increase norepinephrine due to potential for toxicity.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is closer to the time of the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Consistent daily administration is important for maintaining therapeutic levels and symptom control.

Overdose

Symptoms may include somnolence, agitation, hyperactivity, abnormal behavior, gastrointestinal symptoms, tachycardia, hypertension, and mydriasis. In severe cases, seizures or QT prolongation may occur. There is no specific antidote; management involves symptomatic and supportive care, including monitoring of vital signs and ECG. Gastric lavage or activated charcoal may be considered if ingestion was recent. Contact a poison control center or seek emergency medical attention immediately.

Storage

Store at room temperature (20-25°C or 68-77°F), with excursions permitted between 15-30°C (59-86°F). Keep in a tightly closed container, away from light, moisture, and heat. Do not store in the bathroom. Keep out of reach of children and pets. Dispose of unused or expired medication properly via a drug take-back program or according to local guidelines.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here. Individual responses to medication may vary.

Reviews

Clinical studies and patient reports indicate that Strattera is effective for many individuals with ADHD, particularly those who cannot use stimulants. Users often note gradual improvements in focus, organizational skills, and impulse control over several weeks. Some report side effects such as initial nausea or fatigue, which often subside. Reviews highlight appreciation for its non-controlled status and all-day coverage, though some desire a faster onset of action. Overall, it is regarded as a valuable option in comprehensive ADHD management strategies.