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Atomoxetine: ADHD Medication – Effects & Dosage

Atomoxetine is a prescription medication used to treat ADHD in children, adolescents, and adults. Unlike most ADHD drugs, it is not a stimulant.

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Things worth knowing about "Atomoxetine"

Atomoxetine is a prescription medication used to treat ADHD in children, adolescents, and adults. Unlike most ADHD drugs, it is not a stimulant.

What is Atomoxetine?

Atomoxetine is a non-stimulant prescription medication used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Unlike many other ADHD medications, it does not belong to the class of amphetamines or stimulants. It is marketed under the brand name Strattera® and is approved for use in children (aged 6 and above), adolescents, and adults.

Mechanism of Action

Atomoxetine acts as a selective norepinephrine reuptake inhibitor (SNRI). It selectively blocks the norepinephrine transporter in the brain, increasing the concentration of the neurotransmitter norepinephrine in the synaptic cleft. Norepinephrine plays a key role in regulating attention, impulse control, and behavioral regulation. By increasing norepinephrine availability in the prefrontal cortex, atomoxetine helps alleviate the core symptoms of ADHD.

Indications

Atomoxetine is approved for:

Children aged 6 and older with a confirmed ADHD diagnosis
Adolescents with ADHD
Adults with ADHD whose symptoms began in childhood

It is particularly useful when stimulant medications such as methylphenidate are not tolerated, are contraindicated, or when there is a risk of substance misuse.

Dosage

The dosage of atomoxetine is weight-based and individually adjusted. For children and adolescents weighing up to 70 kg, the recommended starting dose is approximately 0.5 mg/kg/day, which may be increased after at least 7 days to a target dose of around 1.2 mg/kg/day. For adults and patients weighing more than 70 kg, treatment typically begins at 40 mg/day and may be increased to a maximum of 100 mg/day. The medication is taken once daily or in two divided doses. The full therapeutic effect often takes several weeks to become apparent.

Side Effects

Like all medications, atomoxetine can cause side effects. Common side effects include:

Decreased appetite and weight loss
Nausea and vomiting
Abdominal pain
Sleep disturbances (insomnia or fatigue)
Increased blood pressure and heart rate
Headache
Dry mouth (in adults)
Mood swings or irritability

Rare but serious side effects may include liver dysfunction and an increased risk of suicidal thoughts in children and adolescents. Medical attention should be sought immediately if any of these occur.

Drug Interactions

Atomoxetine can interact with various other medications. Special caution is advised with:

MAO inhibitors: Concomitant use is contraindicated and may cause life-threatening reactions.
CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): These can significantly increase plasma levels of atomoxetine.
Antihypertensive agents: Interactions may affect blood pressure regulation.
Other noradrenergic substances: The risk of cardiovascular side effects is increased.

Contraindications

Atomoxetine should not be used in patients with:

Known hypersensitivity to the active substance
Narrow-angle glaucoma
Pheochromocytoma (adrenal gland tumor)
Concomitant use of MAO inhibitors
Serious cardiovascular conditions

Treatment Context

Atomoxetine is typically used as part of a comprehensive ADHD management plan that includes, in addition to medication, behavioral therapy, psychosocial support, and educational interventions. Treatment should be regularly monitored by a healthcare professional, with particular attention to growth, cardiovascular function, and mental health.

References

European Medicines Agency (EMA) - Strattera (Atomoxetine) Assessment Report, EMA/CHMP (2021)
Cortese S. et al. - Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults. Lancet Psychiatry 2018; 5(9):727-738
National Institute for Health and Care Excellence (NICE) - Attention deficit hyperactivity disorder: diagnosis and management. NICE Guideline NG87 (2019, updated 2023)

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