Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor (NRI) approved by the FDA for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents, and adults. Unlike traditional stimulant medications, it offers a non-controlled substance option with 24-hour symptom coverage from a single daily dose. Its unique mechanism targets the prefrontal cortex, improving executive function, attention, and behavioral control without potential for abuse or dependence. This makes it a valuable first-line or alternative therapeutic choice for managing ADHD across age groups.

Features

• Active ingredient: Atomoxetine hydrochloride
• Pharmacologic class: Selective norepinephrine reuptake inhibitor (NRI)
• Available formulations: Capsules (10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg)
• Administration: Oral, once or twice daily
• Onset of action: Therapeutic effects typically observed within 2–4 weeks
• Duration: Provides 24-hour symptom control
• Prescription status: Non-controlled substance (not a scheduled drug)

Benefits

• Delivers continuous symptom management without peaks and troughs associated with stimulants
• Eliminates risk of abuse, diversion, or dependence due to non-stimulant mechanism
• Improves core ADHD symptoms: inattention, hyperactivity, and impulsivity
• Enhances executive functioning, including organization, planning, and emotional regulation
• Suitable for patients with comorbid anxiety or tic disorders, where stimulants may be contraindicated
• Allows for flexible dosing without concerns regarding rebound effects or sleep disruption

Common use

Strattera is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in patients aged 6 years and older. It is used as part of a comprehensive treatment program that may include psychological, educational, and social interventions. Clinicians often consider Strattera for patients who have not responded adequately to stimulant medications, cannot tolerate stimulant side effects, have a history of substance use disorder, or present with comorbid conditions such as anxiety disorders or tics. It is also utilized in cases where once-daily dosing is preferred for adherence.

Dosage and direction

Dosing must be individualized based on therapeutic response and tolerability. For children and adolescents up to 70 kg body weight: initiate at 0.5 mg/kg/day, increase after a minimum of 3 days to 1.2 mg/kg/day, either once daily or divided twice daily. Maximum recommended dose is 1.4 mg/kg/day or 100 mg/day, whichever is less. For patients over 70 kg (adults and heavier adolescents): initiate at 40 mg daily, increase after a minimum of 3 days to 80 mg/day, either as single or divided dose. After 2–4 weeks, may increase to 100 mg/day if needed. Maximum dose is 100 mg/day. Administer with or without food. Swallow capsule whole; do not open or chew.

Precautions

Monitor for emergence of agitation, irritability, suicidal thinking, or unusual changes in behavior, particularly during initial months of therapy. Use with caution in patients with cardiovascular diseases; atomoxetine can increase heart rate and blood pressure. Regular monitoring of vital signs is recommended. Hepatic impairment necessitates dosage adjustment; avoid use in patients with severe liver disease. May cause orthostatic hypotension; advise patients to rise slowly from sitting/lying positions. Not recommended in patients with narrow-angle glaucoma. Priapism, though rare, has been reported and requires immediate medical attention.

Contraindications

Hypersensitivity to atomoxetine or any component of the formulation. Concurrent use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome. Patients with narrow-angle glaucoma. Severe cardiovascular disorders where increases in blood pressure or heart rate would be problematic. Pheochromocytoma or history of pheochromocytoma.

Possible side effect

Common adverse reactions (≥5% and twice the rate of placebo) include: nausea, vomiting, fatigue, decreased appetite, abdominal pain, somnolence, dizziness. Less frequent but clinically significant side effects may include: increased heart rate (mean increase ~6 bpm), increased blood pressure (mean increase ~2–4 mm Hg), dry mouth, insomnia, irritability, mood swings, constipation, dyspepsia, hot flashes. In children and adolescents, weight loss may occur during initial months of treatment. Rare but serious effects include severe liver injury, angioedema, urticaria, and suicidal ideation (especially in children and adolescents).

Drug interaction

Strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine) can increase atomoxetine exposure; reduce Strattera dose accordingly. Avoid concomitant use with MAOIs due to risk of hypertensive crisis. Use cautiously with drugs that increase blood pressure or heart rate (e.g., albuterol, pressor agents). Potential pharmacodynamic interaction with other norepinephrine reuptake inhibitors. May enhance effects of salbutamol on cardiovascular system.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is closer to the time of the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Consistent daily administration is important for maintaining therapeutic effect.

Overdose

Symptoms may include somnolence, agitation, hyperactivity, abnormal behavior, gastrointestinal symptoms, tachycardia, hypertension, mydriasis. No specific antidote exists; provide supportive care including monitoring of cardiac function and vital signs. Gastric lavage may be considered if presented early. Dialysis 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, tightly closed. Protect from light and moisture. Keep out of reach of children and pets. Do not use after expiration date printed on packaging.

Disclaimer

This information is for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting, changing, or stopping any medication. Individual response to Strattera may vary. Only a licensed physician can determine the appropriate therapy based on patient-specific factors.

Reviews

Clinical trials demonstrate Strattera’s efficacy in reducing ADHD symptoms across age groups. In pediatric studies, 58–64% of patients showed significant improvement compared to placebo. Adult trials reported similar efficacy with meaningful functional improvement. Many clinicians note its particular value in patients with comorbid anxiety or substance use concerns. Common patient-reported benefits include improved focus, organizational skills, and emotional stability without euphoria or crash effects. Drawbacks include slower onset of action (2–4 weeks) compared to stimulants and gastrointestinal side effects during titration. Long-term studies support its safety profile for continued use.