atomoxetine
Atomoxetine (Strattera) is a non-stimulant medication used to treat attention-deficit hyperactivity disorder (ADHD) in people 6 years of age and older. It's not a controlled substance like many other ADHD medications are. But atomoxetine (Strattera) still has potentially serious risks to consider, such as mental health problems and heart problems.
What is Atomoxetine (Strattera)?
What is Atomoxetine (Strattera) used for?
Attention-deficit hyperactivity disorder (ADHD)
How Atomoxetine (Strattera) works
Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor (NRI). It's not exactly known how the medication treats symptoms of ADHD. But it's thought to raise norepinephrine levels in the brain. This might help improve attention and lower impulsive behavior.
Drug Facts
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What are the side effects of Atomoxetine (Strattera)?
Common Side Effects
- Nausea (26%)
- Dry mouth (20%)
- Low appetite (16%)
- Trouble sleeping (15%)
- Feeling tired (10%)
- Constipation (8%)
- Dizziness (8%)
- Sleepiness (8%)
- Erectile dysfunction (8%)
- Stomach pain (7%)
- Problems urinating (6%)
- Headache (19%)
- Stomach pain (18%)
- Low appetite (16%)
- Sleepiness (11%)
- Vomiting (11%)
- Nausea (10%)
- Feeling tired (8%)
Other Side Effects
- Irritability
- Excessive sweating
- Mood swings
- Racing heart
- Chills
Serious Side Effects
- Suicidal thoughts or behaviors
- Other mental health-related problems: manic episodes, changes in thoughts or behavior, hallucinations, depressed mood, anxiety, panic attacks, feeling angry or irritated
- Liver problems: stomach bloating, stomach pain, yellowing of your skin or the whites of your eyes, confusion
- Heart-related problems: heart attack, stroke, fast heart rate, higher blood pressure than usual
- Painful and prolonged erection (lasting longer than 4 hours)
- Severe allergic reaction: trouble breathing; rash; swelling of the face, lips, tongue, or throat
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Hives or welts
irregular heartbeat
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
redness of the skin
skin rash
Rare
Painful, prolonged erection of your penis
Incidence not known
Convulsions
dark colored urine
fainting
flu-like symptoms
loss of bladder control
muscle spasm or jerking of all extremities
pelvic pain in male
right upper belly pain or tenderness
sudden loss of consciousness
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Acid or sour stomach
belching
bleeding between periods
change in amount of bleeding during periods
change in pattern of monthly periods
decrease in the frequency of urination
decrease in urine amount
decreased appetite
decreased interest in sexual intercourse
difficulty having a bowel movement (stool)
difficulty in passing urine (dribbling)
dizziness
headache
inability to have or keep an erection
indigestion
irritability
loss in sexual ability, desire, drive, or performance
pain or tenderness around the eyes and cheekbones
shortness of breath
sleepiness or unusual drowsiness
stomach discomfort, upset, cramps, or pain
stuffy or runny nose
tightness of the chest
trouble sleeping
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
unusual stopping of menstrual bleeding
unusual tiredness or weakness
vomiting
Less common
Abnormal dreams
abnormal orgasm
back pain
blistering, crusting, irritation, itching, or reddening of the skin
bloated or full feeling
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in hearing
change or problem with discharge of semen
chills
cold sweats
confusion
cracked, dry, or scaly skin
crying
decreased weight
difficulty with moving
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
ear drainage
excess air or gas in the stomach or intestines
feeling of warmth, redness of the face, neck, arms, and occasionally, upper chest
feeling unusually cold
general feeling of discomfort or illness
groin pain
increased or sudden sweating
joint pain
loss of appetite
mood swings
muscle aches, cramping, pains, or stiffness
pain or burning with urination
passing gas
shivering
sinus headache
sleep disorder
swelling of the skin
swollen joints
swollen, tender prostate
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Atomoxetine (Strattera)
Pros
Works well in children and adults for ADHD symptoms
Can take with or without food
Not a controlled substance, so there isn't a risk of addiction or dependence
Available as a lower-cost generic
Cons
Doesn't have as much evidence for improving ADHD symptoms as stimulant medications do
Can take a few weeks before you notice your ADHD symptoms getting better
Only available as capsules that must be swallowed whole
Not completely clear how safe it is in pregnant or breastfeeding females
Pharmacist tips for Atomoxetine (Strattera)
You can take atomoxetine (Strattera) with or without food. If the medication is hurting your stomach, try taking it with food to help.
Swallow the atomoxetine (Strattera) capsules whole. Don't cut, crush, or chew the capsules. Also don't open them; if the powder that's inside the capsule gets into your eye, it can be irritating. If you're having trouble swallowing the capsules, contact your provider to switch to a different medication.
If you miss a dose of atomoxetine (Strattera), take it as soon as you remember. But never take more than the total daily amount prescribed to you in a 24-hour period. This could cause harmful side effects.
Atomoxetine (Strattera) can lower your appetite, which might affect your weight. If you notice concerning changes to your weight, let your provider know.
Atomoxetine (Strattera) can make you sleepy and dizzy. Avoid driving or doing tasks that require attention until you know how this medication affects you. Also, don't drink alcohol because it can make sleepiness and dizziness worse.
Atomoxetine (Strattera) can affect your mood and thoughts, especially when you first start the medication and whenever your dose changes. Let your provider know right away if you feel depressed or have thoughts of self-harm.
Make sure your provider knows all the medications you're taking before you start atomoxetine (Strattera) and during treatment. Atomoxetine (Strattera) interacts with many common medications. For example, certain antidepressants, such as fluoxetine (Prozac), can raise the amount of atomoxetine (Strattera) in your body. This can raise your risk of atomoxetine (Strattera) side effects. Additionally, atomoxetine (Strattera) shouldn't be taken with or within 2 weeks of monoamine oxidase inhibitors (MAOIs) like phenelzine (Nardil) or rasagiline (Azilect). This combination can raise your risk of side effects like high fever, muscle problems, and extreme distress.
Frequently asked questions about Atomoxetine (Strattera)
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What are the risks and warnings for Atomoxetine (Strattera)?
Atomoxetine (Strattera) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Suicidal thoughts
Risk factors: First few months of atomoxetine (Strattera) treatment | Changes in dose | Children 12 years or younger
Atomoxetine (Strattera) can raise the risk of having thoughts of suicide or harming yourself, especially in children and teens. The risk is highest during the first few months of taking the medication and when your dose changes. If you or a loved one notices that your mood has changed, you have unusual behavior (e.g., depressed mood, anxiety, panic attacks, difficulty sleeping, feeling angry, restlessness), or you have suicidal thoughts, call your provider right away.
Severe liver damage
Risk factors: History of liver problems
Rarely, atomoxetine (Strattera) can cause severe liver problems that can possibly lead to liver failure. Liver injury can happen several months after you start the medication. It might also continue for a few weeks after you stop treatment. Seek medical attention right away if you notice swelling of your stomach, yellowing of your skin or the whites of your eyes, stool changes (black, tarry, or bloody stools), dark urine, or upper-right-sided stomach pain. You'll likely need to stop taking atomoxetine (Strattera) to prevent further liver damage.
Serious heart problems
Risk factors: History of heart problems
Stroke, heart attack, and sudden death have been linked to atomoxetine (Strattera) use at usual doses in people with a history of heart problems. This medication can also raise your blood pressure and heart rate. Tell your provider if you have or have had heart problems before starting atomoxetine (Strattera). They'll also check for heart problems before you start treatment. Your provider will make sure atomoxetine (Strattera) is safe for you to take. Contact your provider if you experience unexplained fainting, chest pain with physical activity, or irregular heartbeat while you're taking atomoxetine (Strattera).
Potential worsening of bipolar disorder
Risk factors: Personal or family history of mental health conditions (e.g., bipolar disorder, mania, depression)
People with bipolar disorder might be at a higher risk for manic episodes (extremely excited mood) or mixed episodes of mania and depression during treatment with atomoxetine (Strattera). Before starting this medication, your provider will screen you for bipolar disorder. Talk to your provider right away if you or a loved one notices unusual changes in your behavior, such as racing thoughts, reckless behavior, excessive happiness or irritability, or unusual talkativeness.
Aggressive behavior or other changes in behavior
Risk factors: History of psychotic episodes, bipolar disorder, or other mental health or mood-related conditions
Some people taking atomoxetine (Strattera) have had mental health problems such as hallucinations (seeing things that aren't really there), aggressive behavior, unclear thinking, and mania. This medication might worsen behavior- or mood-related problems that you already have. But these changes in behavior or mood can also happen even if you haven't had these problems before. If you develop these behavior- and mood-related symptoms while taking atomoxetine (Strattera), talk to your healthcare provider immediately because you might have to stop taking it.
Prolonged and painful erection
Although rare, some people taking atomoxetine (Strattera) experienced prolonged and painful erections. When left untreated, this can lead to permanent damage, including the inability to have an erection. If you develop a painful erection that lasts longer than 4 hours, stop taking atomoxetine (Strattera) and get medical attention right away.
Slowed growth in children
In studies, children taking atomoxetine (Strattera) had a slower growth rate (in both height and weight). This slowed growth happened during the first 9 to 12 months of treatment. But studies also showed that their growth typically bounced back as they continued treatment. Your child's provider will track your child's growth progress closely. If they suspect slowed growth, they might pause or stop your child's atomoxetine (Strattera) treatment. Talk to your child's provider if you have concerns.
Atomoxetine (Strattera) dosage forms
Typical dosing for Atomoxetine (Strattera)
This medication can be taken all at once in the morning. It can also be taken as two evenly-divided doses during the day (once in the morning, and once in the late afternoon/early evening).
Children weighing over 154 lbs (70 kg) and Adults: The typical starting dose is 40 mg by mouth per day. After about 3 days, your provider will raise your dose to 80 mg per day. The maximum daily dose is 100 mg.
Adults and children weighing 154 lbs (70 kg) or less: The typical starting dose is 0.5 mg/kg of body weight by mouth per day. After about 3 days, the dose is raised to 1.2 mg/kg per day. The maximum dose is 1.4 mg/kg per day (or 100 mg per day, whichever is less).
Your dose might differ if you have liver problems or if you're taking a medication that interacts with atomoxetine (Strattera).
Interactions between Atomoxetine (Strattera) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Isocarboxazid
- Linezolid
- Methylene Blue
- Phenelzine
- Procarbazine
- Rasagiline
- Safinamide
- Selegiline
- Tranylcypromine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Albuterol
- Bupropion
- Darunavir
- Donepezil
- Givosiran
- Panobinostat
- Paroxetine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amitriptyline
- Amoxapine
- Clomipramine
- Desipramine
- Dibenzepin
- Dothiepin
- Imipramine
- Lofepramine
- Nortriptyline
- Opipramol
- Protriptyline
- Trimipramine
How much does Atomoxetine (Strattera) cost?
Atomoxetine (Strattera) contraindications
Taking a monoamine oxidase inhibitor (MAOI) currently or within the last 14 days
Narrow-angle glaucoma
Pheochromocytoma (a type of adrenal gland tumor)
Certain severe heart or blood vessel problems
What are alternatives to Atomoxetine (Strattera)?
Attention-deficit hyperactivity disorder (ADHD)
Attention-deficit hyperactivity disorder (ADHD) in adults and children age 6 years and older
What is the latest news about Atomoxetine (Strattera)?
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References
Best studies we foundClemow, D. B., et al. (2015). Atomoxetine in patients with ADHD: A clinical and pharmacological review of the onset, trajectory, duration of response and implications for patients. Journal of Psychopharmacology.
De Crescenzo, F., et al. (2018). Noradrenaline reuptake inhibitors (NRIs) for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane Database of Systematic Reviews.
Drugs and Lactation Database (LactMed). (2023). Atomoxetine. National Institute of Child Health and Human Development.
Gayleard, J. L., et al. (2017). Atomoxetine treatment for children and adolescents with attention-deficit/hyperactivity disorder (ADHD): a comprehensive meta-analysis of outcomes on parent-rated core symptomatology. Attention Deficit and Hyperactivity Disorders.
Mechler, K., et al. (2022). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics.
National Cancer Institute. (2020). Pheochromocytoma.
National Institute of Mental Health. (2023). Bipolar disorder.
National Institute on Drug Abuse. (2023). Misuse of prescription drugs research report overview.
Silberman, M., et al. (2023). Priapism. StatPearls.
Teva Pharmaceuticals USA, Inc. (2022). ATOMOXETINE capsule [package insert]. DailyMed.
Upadhyaya, H., et al. (2015). Time-to-onset and -resolution of adverse events before/after atomoxetine discontinuation in adult patients with ADHD. Postgraduate Medicine.
Vanicek, T., et al. (2016). The norepinephrine transporter in attention-deficit/hyperactivity disorder investigated with positron emission tomography. JAMA Psychiatry.
Wietecha, L. A., et al. (2016). Atomoxetine increased effect over time in adults with attention-deficit/hyperactivity disorder treated for up to 6 Months: Pooled analysis of two double-blind, placebo-controlled, randomized trials. CNS Neuroscience & Therapeutics.
Wolraich, M. L., et al. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics.
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