Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor approved for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents, and adults. Unlike traditional stimulant medications, it offers a non-controlled substance option with a unique mechanism of action that provides 24-hour symptom coverage from a single daily dose. Its efficacy in improving attention, reducing impulsivity, and helping manage hyperactive behaviors is well-supported by clinical evidence, making it a foundational choice for long-term ADHD management.

Features

• Active ingredient: Atomoxetine hydrochloride
• Available in capsules: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg
• Non-stimulant, non-controlled substance (not a Schedule II drug)
• Selective norepinephrine reuptake inhibitor (SNRI)
• Once-daily or twice-daily dosing regimens
• FDA-approved for pediatric (ages 6+), adolescent, and adult ADHD

Benefits

• Provides continuous, all-day symptom control without peaks and troughs associated with short-acting stimulants
• Reduces core ADHD symptoms: inattention, hyperactivity, and impulsivity
• Non-addictive profile lowers potential for abuse or diversion
• May improve social and family functioning through better behavioral regulation
• Suitable for patients with comorbid anxiety or tic disorders, where stimulants may be contraindicated
• Does not require routine cardiac monitoring in healthy patients

Common use

Strattera is indicated for the management of ADHD in patients aged 6 years and older. It is often selected for individuals who have not tolerated stimulant medications, have a history of substance misuse, or require around-the-clock symptom control. It may also be preferred in cases where comorbidities such as anxiety disorders or tics are present. Clinical response is typically observed within 2–4 weeks of initiating therapy, with full therapeutic benefits often realized after 6–8 weeks of consistent use.

Dosage and direction

Dosing is weight-based for patients under 70 kg: initiate at approximately 0.5 mg/kg/day, increase after a minimum of 3 days to a target daily dose of 1.2 mg/kg, administered either once daily or divided into two doses (morning and late afternoon/early evening). For patients over 70 kg, start at 40 mg daily, increase after 3 days to 80 mg/day, and after 2–4 weeks may increase to a maximum of 100 mg/day if needed. Capsules should be swallowed whole and may be taken with or without food. Avoid opening or chewing capsules.

Precautions

Monitor for the emergence of agitation, irritability, suicidal thinking, or unusual changes in behavior, particularly during the initial months of therapy or after dosage changes. Liver function should be assessed in patients presenting with symptoms such as jaundice, dark urine, or right upper quadrant tenderness. Use caution in patients with hypertension, tachycardia, or cardiovascular disease. Atomoxetine may cause orthostatic hypotension and syncope, especially early in treatment. Sexual dysfunction, including erectile disturbances and libido changes, has been reported. Priapism is a rare but serious adverse event requiring immediate medical attention.

Contraindications

Strattera is contraindicated in patients with narrow-angle glaucoma, due to increased risk of mydriasis. It should not be used within 2 weeks of discontinuing an MAO inhibitor due to risk of serotonin syndrome. It is also contraindicated in patients with severe cardiovascular disorders that could be exacerbated by increases in heart rate or blood pressure. Hypersensitivity to atomoxetine or any component of the formulation prohibits use.

Possible side effects

Common side effects include:

• Nausea, vomiting, abdominal pain
• Decreased appetite, weight loss
• Drowsiness, fatigue
• Dizziness
• Mood swings, irritability

Less common but serious side effects may include:

• Suicidal ideation (particularly in children and adolescents)
• Severe liver injury
• Cardiovascular events (increased heart rate, blood pressure)
• Allergic reactions (rash, angioedema)
• Priapism
• Urinary retention

Drug interaction

Atomoxetine is primarily metabolized by CYP2D6. Concomitant use with strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine) may significantly increase atomoxetine levels—consider dose reduction. Avoid use with MAOIs due to risk of hypertensive crisis. Use caution with drugs that increase blood pressure or heart rate (e.g., albuterol, pressors). Atomoxetine may enhance effects of vasopressors. Avoid use with other SNRIs or drugs affecting norepinephrine due to additive effects.

Missed dose

If a dose is missed, it should be taken as soon as possible on the same day. However, if it is near the time of the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one.

Overdose

Symptoms of overdose may include drowsiness, agitation, hyperactivity, abnormal behavior, gastrointestinal symptoms, tachycardia, and hypertension. In severe cases, QT prolongation or seizures may occur. There is no specific antidote; provide symptomatic and supportive care. Gastric lavage and activated charcoal may be considered if presented early. Monitor ECG and vital signs continuously.

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. Keep out of reach of children and pets.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Individual patient responses may vary.

Reviews

Clinical trials and post-marketing studies demonstrate Strattera’s efficacy in reducing ADHD symptoms across age groups. Many patients and clinicians report improved focus, organizational skills, and emotional regulation. However, gastrointestinal side effects and initial fatigue are frequently noted. Long-term users often appreciate the non-stimulant nature and consistent daily coverage. Adherence to dosing and patience during the titration phase are commonly emphasized for optimal outcomes.