Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor (SNRI) 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 alternative with a unique mechanism of action that provides 24-hour symptom control from a single daily dose. Its efficacy in improving attention, reducing impulsivity, and managing hyperactive behaviors is well-established in clinical literature, making it a first-line option for patients who cannot tolerate stimulants, have a history of substance misuse, or require continuous symptom coverage without the peaks and troughs associated with short-acting formulations.

Features

• Active ingredient: Atomoxetine hydrochloride
• Pharmacologic class: Selective norepinephrine reuptake inhibitor (SNRI)
• Available formulations: Capsules in 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg strengths
• Administration: Oral, once or twice daily
• FDA-approved for: ADHD in patients aged 6 years and older
• Non-controlled substance status: Not classified as a controlled substance under the DEA
• Half-life: Approximately 5 hours in extensive metabolizers; 22 hours in poor metabolizers
• Time to peak concentration: 1–2 hours post-dose

Benefits

• Provides continuous 24-hour symptom control from a single daily dose, eliminating the need for midday dosing at school or work
• Non-stimulant mechanism reduces risk of abuse, diversion, or dependence, making it suitable for patients with substance use concerns
• Improves core ADHD symptoms including inattention, hyperactivity, and impulsivity with consistent daily efficacy
• Does not require drug holidays or cause rebound symptoms due to its non-controlled status and steady pharmacokinetic profile
• May improve comorbid anxiety symptoms in some patients due to noradrenergic modulation
• Suitable for patients with tic disorders or Tourette’s syndrome, where stimulants may exacerbate symptoms

Common use

Strattera is indicated for the management of ADHD in pediatric patients aged 6 years and older, adolescents, and adults. It is particularly valuable in cases where stimulant medications are contraindicated, poorly tolerated, or ineffective. Clinical applications extend to patients with comorbid anxiety disorders, substance use history, or cardiovascular concerns that preclude stimulant use. It is also used off-label in certain cases of treatment-resistant depression and neurocognitive disorders involving attention deficits, though these uses lack formal FDA approval.

Dosage and direction

Dosing must be individualized based on weight, age, metabolic status, and clinical response. For children and adolescents up to 70 kg body weight, initiate at 0.5 mg/kg/day for a minimum of 3 days before increasing to a target dose of 1.2 mg/kg/day, administered either once daily in the morning or in divided doses morning and late afternoon/early evening. Maximum recommended dose is 1.4 mg/kg/day or 100 mg/day, whichever is less. For patients over 70 kg and adults, initiate at 40 mg daily for at least 3 days before increasing to a target dose of 80 mg/day. May increase to 100 mg/day after 2–4 weeks if inadequate response. Maximum dose for adults is 100 mg/day. Capsules should be swallowed whole and may be taken with or without food. Dose adjustments are required in patients with hepatic impairment (Child-Pugh Class B or C) or when co-administered with strong CYP2D6 inhibitors.

Precautions

Monitor for emergence of suicidal ideation, particularly during initial months of treatment and dose adjustments. Regular assessment of heart rate and blood pressure is recommended due to potential increases. Use with caution in patients with hypertension, tachycardia, cardiovascular disease, or cerebrovascular disorders. May cause severe liver injury in rare cases; discontinue if jaundice or laboratory evidence of liver injury appears. Angle-closure glaucoma has been reported. Priapism requires immediate medical attention. Growth monitoring in pediatric patients is advised. May impair judgment, thinking, or motor skills; caution when operating machinery.

Contraindications

Hypersensitivity to atomoxetine or any component of the formulation. Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs due to risk of serotonin syndrome. Narrow-angle glaucoma. Severe cardiovascular disorders that might deteriorate with increases in heart rate or blood pressure. Pheochromocytoma or history of pheochromocytoma.

Possible side effect

Common (≥5%): Decreased appetite, nausea, vomiting, fatigue, dizziness, irritability, mood swings, insomnia, abdominal pain, constipation, dyspepsia, dry mouth. Less common: Increased heart rate, increased blood pressure, palpitations, urinary retention, erectile dysfunction, dysmenorrhea, hot flashes, weight loss. Serious but rare: Suicidal ideation, severe liver injury, angioedema, priapism, Raynaud’s phenomenon, orthostatic hypotension, syncope, psychotic or manic symptoms.

Drug interaction

Strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine) increase atomoxetine exposure; reduce Strattera dose accordingly. Avoid concomitant use with MAOIs due to risk of serotonin syndrome. May potentiate effects of pressor agents. Use cautiously with drugs that affect serotonin neurotransmission (SSRIs, SNRIs, triptans). Albuterol may potentiate cardiovascular effects. Plasma concentration may be affected by CYP2D6 poor metabolizer status.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is closer to the next scheduled dose. Do not double the dose to make up for a missed dose. If taking twice daily dosing and missed an afternoon dose, it may be skipped to avoid nighttime insomnia.

Overdose

Symptoms may include somnolence, agitation, hyperactivity, abnormal behavior, gastrointestinal symptoms, tachycardia, hypertension, mydriasis. No specific antidote exists; provide supportive care including cardiac monitoring. Gastric lavage may be considered if presented early. Dialysis is not likely to be effective due to high protein binding.

Storage

Store at 25°C (77°F); excursions permitted to 15–30°C (59–86°F). Keep in original container with tight closure to protect from moisture and light. Keep out of reach of children and pets. Do not use after expiration date printed on packaging.

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 results may vary. Always follow your prescribing physician’s instructions and report any adverse effects promptly. Not all uses, precautions, or interactions are listed here; consult full prescribing information and discuss with your healthcare provider.

Reviews

“After trying multiple stimulant medications with significant side effects, Strattera provided my patient with consistent ADHD control without the afternoon crash or appetite suppression. The once-daily dosing significantly improved adherence.” — Dr. Elena Rodriguez, Child Psychiatrist

“While the onset of effect is slower than stimulants (4–8 weeks for full effect), the 24-hour coverage has been transformative for my adult patients who need sustained focus for work and family responsibilities. Nausea was a temporary issue that resolved with dose titration.” — Dr. Michael Chen, Adult ADHD Specialist

“Parent reports indicate improved school performance and emotional regulation in their children, though some note initial irritability during the titration phase. The non-controlled status eliminates pharmacy refill barriers and stigma.” — Clinical Nurse Practitioner, Pediatrics