What to Know about Atomoxetine (Strattera)

Attention-deficit hyperactivity disorder (ADHD) is one of the most common mental conditions and can feel frustrating and overwhelming, if you can’t access personalized care. For those with ADHD, taking medication can be a significant step towards improving their mental health.

A medication often used to treat ADHD is atomoxetine (also known by the brand name Strattera). On this page, we’ve outlined some important information about the drug.

What is atomoxetine (Strattera)?

What is atomoxetine? How does it work?

Atomoxetine is a selective norepinephrine reuptake inhibitor approved to treat attention-deficit hyperactivity disorder (ADHD). It may sometimes be used off-label to treat mood disorders, eating disorders, cognitive dysfunction, and addiction. 

Atomoxetine belongs to a class of medications called selective norepinephrine reuptake inhibitors (SNRIs). It works by preventing the reabsorption of a chemical in the brain called norepinephrine. This in turn leads to higher levels of norepinephrine in the brain that helps improve attention and reduce hyperactivity.  

How should Atomoxetine be used?

Atomoxetine comes in 10, 18, 25, 40, 60, 80, or 100 mg tablets and is to be taken orally with or without food once or twice daily as instructed by your doctor. Most adults start off taking atomoxetine 40 mg once daily; this dosage is sometimes increased to 80 mg which can be taken as a single dose in the morning or as evenly divided doses in the morning and early evening. Some may require a maximum of 100 mg daily if they do not show an optimal response to lower doses. Often your doctor will start you off on a lower dosage and gradually increase the dose to prevent any adverse reactions. 

People with certain medical conditions like allergy to atomoxetine, certain cardiovascular or liver problems, narrow angle glaucoma, pheochromocytoma or those who take MAOI antidepressants should not take atomoxetine.

You should not change your atomoxetine regimen without consulting your doctor. Stopping atomoxetine abruptly can cause undesirable withdrawal symptoms; any changes in medication regimen should be cleared with your doctor first. When you are ready to stop taking atomoxetine, your doctor will likely lower your dose over time to help your body adjust to the withdrawal process. This is called “tapering”. 

What are some possible side effects?

Some common side effects of Atomoxetine include:

  • Heartburn
  • Nausea and vomiting
  • Stomachache
  • Irritability
  • Headaches
  • Loss of appetite
  • Constipation
  • Sweating 
  • Dry mouth

Some serious (but uncommon side effects) include:

  • Dizziness or faintness
  • Fast or pounding heartbeat
  • Shortness of breath
  • Low or difficult speech
  • Itchy skin
  • Weakness or numbness of an arm or leg
  • Dark urine
  • Priapism (prolonged erection)
  • Psychosis (hallucinations, delusional thinking)
  • Mania
  • Aggression
  • Suicidality

Call 911 or seek emergency care if you notice any severe side effects. You can find a more comprehensive list of atomoxetine side effects here

Why do these side effects occur? 

Any medication can potentially lead to side effects, and a person’s likelihood of having side effects depends on many factors, including age, lifestyle, and the type of medication itself. Side effects may occur because drugs often have broad or poorly targeted effects, or the drug target itself may have many downstream effects on the body.

Atomoxetine acts by increasing the levels of certain chemicals called neurotransmitters in the brain. These chemicals handle several functions of the brain and other organs in the body, from breathing to concentration and even learning. Neurotransmitters also affect mood and other psychological states. Changing neurotransmitter levels in the body can sometimes affect some of these other functions, causing side effects. 

Many non-serious side effects of mental health medications like atomoxetine go away after a few weeks as your body gets used to the medication. However, if a side effect persists, is intolerable, or severely hinders your ability to go about your daily life, talk to your doctor, because this might be a sign of a deeper problem. 

How do your genes relate to atomoxetine?

Genetics can affect your body’s response to medication. Studies have shown that the CYP2D6 gene can affect the use of atomoxetine. Some people with a certain variation of CYP2D6 might be slow metabolizers for atomoxetine. Being a slow metabolizer means your body will break down the medication more slowly than others, which means the drug sticks around for longer than intended and may lead to side effects. For slow metabolizers, a doctor might opt to prescribe a different medication or prescribe a lower dosage. 

One way to predict whether you’ll have a positive outcome while taking atomoxetine is by taking a genetic test to determine what genetic variations you have and how they affect medication metabolization. Your DNA can help your doctor rule out less suitable medications and make more informed decisions so that you can get better, faster.

Special Precautions

  • It is important that your doctor keeps tabs on your progress when using atomoxetine to ensure the medication is working properly at the recommended dose. 
  • Notify your doctor if you have any history of allergies with atomoxetine or any other medication. 
  • Breastfeeding mothers should only take atomoxetine when prescribed by a doctor who must have confirmed that the benefits of taking the medication outweighs the potential risks. 
  • Atomoxetine may make you dizzy, drowsy, or lightheaded. Avoid driving or handling heavy machines if the medication makes you feel this way.
  • Inform your doctor if you have a family history of heart disease as atomoxetine has been linked to serious heart and blood vessel problems. 
  • Notify your doctor immediately if you notice any unusual changes in behavior such as aggressiveness, irritability, suicidal thoughts or if you are having hallucinations. 

If you show signs of an allergic reaction to atomoxetine (hives, difficulty breathing, rash, swelling), call 911 or go to the nearest emergency department.

Some medications, vitamins, and herbs may interfere with how atomoxetine works. Make sure to tell your doctor about all other medications you are taking before starting atomoxetine to avoid negative interactions. For full details, see the FDA’s full list of precautions

Looking to find the right medication for your mental health? Join Prairie today to connect to expert providers and affordable medication options. 

Authors

  • Karen Lim, MD is a double board certified psychiatrist in General and Child & Adolescent Psychiatry. She graduated with her medical degree from Case Western Reserve University and completed her residency and fellowship at UCLA. Dr. Lim has worked around the world (the USA, South Pacific, Asia and the Middle East) at all levels of care, inpatient, outpatient and telepsychiatry.

  • Prairie Health is an online psychiatry service focused on reducing all barriers to mental healthcare and modernizing treatment. Prairie specializes in helping adults with depression or anxiety get better through online psychiatry appointments, genetics-informed medication plans and ongoing support, all from the comfort of home.

Published
Categorized as Medication

By Karen Lim, MD

Karen Lim, MD is a double board certified psychiatrist in General and Child & Adolescent Psychiatry. She graduated with her medical degree from Case Western Reserve University and completed her residency and fellowship at UCLA. Dr. Lim has worked around the world (the USA, South Pacific, Asia and the Middle East) at all levels of care, inpatient, outpatient and telepsychiatry.