Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor (SNRI) approved by the FDA for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents, and adults. Unlike traditional stimulant medications, Strattera offers a non-controlled substance alternative with 24-hour symptom coverage, making it particularly valuable for patients who cannot tolerate stimulants, have comorbid anxiety, or require around-the-clock symptom control. Its unique mechanism of action modulates norepinephrine pathways in the prefrontal cortex, improving executive functioning, attention regulation, and impulse control without potential for abuse or dependence.

Features

• Active ingredient: Atomoxetine hydrochloride
• Available in capsules: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg
• Non-controlled substance (not scheduled)
• 24-hour duration of action with once or twice daily dosing
• Multiple evidence-based dosing strategies (weight-based and fixed-dose)
• FDA-approved for ages 6 and older
• Available as brand and generic formulations

Benefits

• Provides continuous ADHD symptom management without stimulant-related side effects
• Eliminates concerns about drug abuse, diversion, or dependence potential
• Improves executive functioning, including organization, planning, and task completion
• Reduces emotional lability and rejection sensitive dysphoria associated with ADHD
• May be used in patients with comorbid anxiety disorders without exacerbation
• Offers flexible dosing without the “rebound” effects seen with short-acting stimulants

Common use

Strattera is primarily indicated for the treatment of ADHD in pediatric patients (ages 6+) and adults. It addresses core ADHD symptoms including inattention, hyperactivity, and impulsivity. Clinicians often prescribe Strattera when patients cannot tolerate stimulant medications, have a history of substance use disorder, or require 24-hour symptom coverage. The medication is particularly beneficial for patients with comorbid anxiety disorders, as it does not typically exacerbate anxiety symptoms like stimulants might. Many patients report improvements in emotional regulation and executive functioning beyond basic attention metrics.

Dosage and direction

Initial dosing: For children and adolescents up to 70 kg body weight: Start with 0.5 mg/kg/day for minimum of 3 days, then increase to 1.2 mg/kg/day. For patients over 70 kg and adults: Start with 40 mg daily for minimum of 3 days, then increase to 80 mg daily. Maximum recommended dose: 100 mg daily or 1.4 mg/kg/day, whichever is less.

Administration: Capsules should be swallowed whole with water. May be taken with or without food, though consistent administration with food may reduce gastrointestinal side effects. For once-daily dosing, administer in the morning; for twice-daily dosing, administer morning and late afternoon/early evening. Dose adjustments should occur at intervals of at least 3 days to assess tolerance.

Titration: Therapeutic effects typically emerge within 1-4 weeks of reaching target dose. Full therapeutic benefit may take 6-8 weeks. Regular monitoring of efficacy and side effects is essential during dose titration.

Precautions

Hepatic impairment: Use with caution in patients with liver disease; reduced dosing required. Consider baseline liver function tests and periodic monitoring. Cardiovascular assessment: Evaluate blood pressure and heart rate at baseline and periodically during treatment. Use caution in patients with hypertension, tachycardia, or cardiovascular disease. Growth monitoring: Pediatric patients should have height and weight monitored regularly. Urinary retention: Monitor for difficulty urinating, especially in patients with pre-existing urinary symptoms. Angle-closure glaucoma: May precipitate angle-closure attack in susceptible individuals. Emotional changes: Monitor for emerging anxiety, agitation, or mood changes. Pregnancy: Category C - use only if potential benefit justifies potential risk. Nursing mothers: Atomoxetine is excreted in human milk; caution advised.

Contraindications

Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy. Known hypersensitivity to atomoxetine or any component of the formulation. Narrow-angle glaucoma. Severe cardiovascular disorders that might be exacerbated by increases in blood pressure or heart rate. Pheochromocytoma or history of pheochromocytoma. Severe hepatic impairment (Child-Pugh Class C).

Possible side effects

Common (≥5%): Decreased appetite (15-22%), nausea (10-26%), fatigue (8-11%), dizziness (5-8%), dry mouth (15-20%), insomnia (8-15%), abdominal pain (12-18%), vomiting (5-11%), constipation (8-10%), dyspepsia (5-6%), mood swings (2-8%), irritability (5-7%)

Less common (1-5%): Palpitations, tachycardia, hypertension, hot flashes, weight loss, sexual dysfunction (decreased libido, erectile dysfunction), urinary hesitation, sweating, rash

Rare (<1%): Liver injury (evidenced by elevated liver enzymes), orthostatic hypotension, syncope, Raynaud’s phenomenon, priapism, suicidal ideation (particularly in children and adolescents)

Serious but rare: Severe liver injury, angioedema, urticaria, anaphylactic reactions, psychotic or manic symptoms

Drug interaction

Strong CYP2D6 inhibitors: Paroxetine, fluoxetine, quinidine - may increase atomoxetine levels; reduce Strattera dose accordingly MAOIs: Contraindicated due to risk of serotonin syndrome Blood pressure medications: May reduce efficacy of antihypertensive drugs Albuterol: May potentiate cardiovascular effects Vasopressors: May enhance pressor effects SSRIs/SNRIs: Potential additive serotonergic effects CYP2D6 substrates: May affect metabolism of other CYP2D6 substrates

Missed dose

If a dose is missed, it should be taken as soon as possible on the same day. However, if it is nearing the time for the next scheduled dose, the missed dose should be skipped. Doubling up on doses is not recommended. For patients taking twice-daily dosing, if a dose is missed, the next dose should be taken at the regular time. Consistent daily administration is important for maintaining therapeutic effects. Patients should not make up missed doses at the end of the day if taking once-daily morning dosing, as this may cause insomnia.

Overdose

Symptoms may include drowsiness, agitation, hyperactivity, abnormal behavior, gastrointestinal symptoms (nausea, vomiting), tachycardia, hypertension, mydriasis, and dry mouth. Severe overdose may involve serotonin syndrome symptoms (agitation, hallucinations, coma, autonomic instability), seizures, or QT prolongation. There is no specific antidote for atomoxetine overdose. Management involves supportive care, including cardiac monitoring for at least 24 hours, symptomatic treatment, and activated charcoal if presented early. Hemodialysis is not likely to be effective due to high protein binding.

Storage

Store at room temperature (20-25°C/68-77°F); excursions permitted to 15-30°C (59-86°F). Keep in original container with tight closure. Protect from light and moisture. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Do not transfer capsules to other containers. Unused medication should be disposed of properly through medication take-back programs.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Strattera is a prescription medication that should be used only under the supervision of a qualified healthcare provider. Individual response to medication may vary. Patients should not initiate, discontinue, or change dosage without consulting their prescribing physician. The complete prescribing information should be reviewed before initiating therapy. Only a healthcare professional can determine the appropriate treatment based on individual medical history, current medications, and specific health circumstances.

Reviews

Clinical trials demonstrate Strattera’s efficacy in ADHD symptom reduction across age groups. In pediatric studies, 58-64% of patients showed significant improvement compared to 30-40% on placebo. Adult studies show similar efficacy patterns with effect sizes of 0.4-0.6. Patient-reported outcomes frequently note improvements in emotional regulation, organizational skills, and interpersonal functioning. Many appreciate the 24-hour coverage without stimulant side effects. However, some report slower onset of action compared to stimulants and gastrointestinal side effects during initiation. Long-term studies show maintained efficacy with continuous treatment over 2+ years. Real-world evidence supports its particular value in patients with comorbid anxiety, substance use history, or need for consistent daily coverage.