Atomoxetine
Generic: atomoxetine hydrochloride · Brand: Strattera® · Class: Non-Stimulant — Selective NRI
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How It Works
Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) — the first non-stimulant FDA-approved specifically for ADHD. Unlike stimulants, it works exclusively through norepinephrine (not dopamine) and is not a controlled substance. It works gradually over weeks rather than hours, and provides steady 24-hour ADHD symptom control without peaks and valleys. It is particularly useful when stimulants cause intolerable anxiety, when there is a history of substance misuse, or when ADHD co-occurs with anxiety. Full effect takes 4–8 weeks.
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What It Treats
ADHD in Children 6+FDA-approved; first non-stimulant approved for ADHD
ADHD in AdultsFDA-approved; preferred when stimulants are contraindicated or not tolerated
ADHD with AnxietyDoes not worsen anxiety — often helpful when anxiety is comorbid with ADHD
History of Substance MisuseNot a controlled substance — no abuse potential
24-Hour CoverageSteady-state levels provide consistent symptom control including mornings and evenings
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Dosing Overview
| Population | Start | Typical Range | Max |
|---|---|---|---|
| Children under 70 kg ADHD | 0.5 mg/kg/day | 1.2 mg/kg/day | 1.4 mg/kg/day |
| Children over 70 kg ADHD | 40 mg/day | 80–100 mg/day | 100 mg/day |
| Adults ADHD | 40 mg/day | 80–100 mg/day | 100 mg/day |
Can be taken once daily in the morning or split into morning and evening doses. Take with or without food — food reduces nausea. Full effect takes 4–8 weeks. Do not stop abruptly.
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Side Effects
Common
- Nausea (especially early)
- Decreased appetite
- Fatigue or drowsiness
- Dry mouth
- Constipation
- Increased heart rate
- Sexual side effects in adults
- Mood swings early in treatment
Call us if you notice
- Suicidal thoughts (black box warning)
- Liver damage signs (jaundice, dark urine)
- Chest pain or palpitations
- Significant blood pressure elevation
- Severe mood changes or hostility
- Priapism (rare)
Atomoxetine takes 4–8 weeks for full effect — do not judge effectiveness too early. Nausea is most common early on and improves significantly with food and time. It is not a stimulant, has no abuse potential, and can be prescribed without controlled substance restrictions.
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Tips for Success
Give It TimeFull effect takes 4–8 weeks. Do not stop early — initial weeks are not representative of full benefit.
With FoodAlways take with food to reduce nausea, especially in the first few weeks.
Not a StimulantAtomoxetine works differently than stimulants and has no abuse potential.
Tell All ProvidersInteracts with MAOIs and some antidepressants — always share your full medication list.
Track Progress WeeklyChanges are gradual — weekly tracking helps you and your provider see improvement.
Monitor Blood PressureCheck blood pressure periodically — atomoxetine can raise it modestly.
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Important Safety Information
Black Box Warning — Suicidal Thinking: Atomoxetine may increase suicidal thinking in children and adolescents, especially early in treatment. Monitor closely for mood changes, agitation, or self-harm thoughts. Contact your provider immediately if these occur.
Liver Toxicity (Rare): Rare cases of severe liver injury have been reported. Seek emergency care for jaundice (yellow skin or eyes), dark urine, abdominal pain, or fatigue.
Cardiovascular Effects: Can raise heart rate and blood pressure. Tell your provider about any heart conditions. Periodic blood pressure monitoring is recommended.
Pregnancy: Discuss risks and benefits with your provider.
MAOI Interaction: Do not use within 14 days of an MAOI — can cause dangerous reactions.
Questions? I am here.
Reach me between appointments if you have concerns about side effects, notice mood changes, or have questions about your medication.
360-389-3712
info@rootedmindspsychiatry.com