ADHD and Atomoxetine

Atomoxetine was the first non-stimulant approved for ADHD in children and the first drug approved for ADHD in adults. Approved by the Federal Drug and Administration in 2003, the drug is sold under the brand name Strattera.

Atomoxetine is a selective norepinephrine reuptake inhibitor. This means that is blocks the reabsorption of norepinephrine, increasing its overall availability. Unlike stimulants that work on the dopaminergetic system, atomoxetine targets the noradrenergic system. In addition to reducing the symptoms of ADHD, atomoxetine may also help reduce the symptoms of depression and anxiety.Atomoxetine is a non-addictive drug and, thus, is considered safe for individuals at risk for substance abuse. Atomoxetine is also conveniently obtained: prescriptions can be written for more than a month at a time and doctors can give out free samples.¹

Read more details about Atomoxetine.

Atomoxetine is considered a second-line therapy in the treatment of ADHD. More research is needed to determine whether atomoxetine is as effective at reducing the symptoms of ADHD as stimulants.² That said atomoxetine has been shown to be effective in reducing the symptoms of ADHD in children, adolescents and adults, in a variety of different settings. In a study of 297 children age 8 to 18, atomoxetine proved to be better than a placebo in reducing the symptoms of ADHD and in improving social and family functioning.³ Similarly, two randomized, placebo-controlled studies showed that atomoxetine was effective in reducing the symptoms of ADHD in adults. The studies also showed that atomoxetine is less vulnerable to abuse.⁴ Both studies, however, were conducted in the laboratories of atomoxetine’s main distributor—the Eli Lilly Company.

Atomoxetine comes in the form of a capsule and can be taken once or twice a day. The capsules should be consumed whole and never broken open or chewed. This can be somewhat of a disadvantage for young children who may have difficulty swallowing the pills whole. For children under 70 kilos, the minimum recommended amount is .5 mg per kilo of body weight with a targeted total daily dose of 1.2 mg per kilo after three days. For children over 70 kilos, the minimum recommended amount is 40 mgs, titrating up to twice that amount after three days. The maximum recommended amount is 80 mg for children and 100 mg for adults. Although rapidly absorbed by the system (atomoxetine reaches peak concentration between 1 and 2 hours after ingestion), it generally takes longer to reach a therapeutic dose than to do so with stimulants.

Medical practitioners and psychiatrists

What are the precautions when taking this medicine?

• You may have certain heart tests before starting this medicine. Talk with healthcare provider.

• If you have a fast heartbeat, talk with healthcare provider.

• If you have heart disease, talk with healthcare provider.

• If you have high blood pressure, talk with healthcare provider.

• If you have liver disease, talk with healthcare provider.

• If you have mental illness, talk with healthcare provider.

• Check medicines with healthcare provider. This medicine may not mix well with other medicines.

• If you are taking this medicine and have high blood pressure, talk with healthcare provider before using over-the-counter products that may increase blood pressure. These include cough or cold remedies, diet pills, stimulants, ibuprofen or like products, and certain natural products or supplements.

• Avoid caffeine (for example, tea, coffee, cola) and chocolate intake. Use with this medicine may cause nervousness, shakiness, and fast heartbeat.

• Tell healthcare provider if you are pregnant or plan on getting pregnant.

What are some possible side effects of this medicine?

• Feeling dizzy. Rise slowly over several minutes from sitting or lying position. Be careful climbing.

• High blood pressure.

• Headache.

• Belly pain.

• Inability to sleep.

• Nausea or vomiting. Small frequent meals, frequent mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.

• Not hungry.

• Nasal congestion.

• Dry mouth. Frequent mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.

• Constipation. More liquids, regular exercise, or a fiber-containing diet may help. Talk with healthcare provider about a stool softener or laxative.

• Change in sexual ability or desire. This is usually reversible.

• Liver damage can rarely occur.

Reasons to call healthcare provider immediately

• If you suspect an overdose, call your local poison control center or emergency department immediately.

• Signs of a life-threatening reaction. These include wheezing; chest tightness; fever; itching; bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat.

• Signs or symptoms of depression, suicidal thoughts, nervousness, emotional ups and downs, abnormal thinking, anxiety, or lack of interest in life.

• Chest pain or pressure, fast heartbeat, or passing out.

• Severe behavioral problems.

• Flu-like symptoms.

• Severe belly pain.

• Severe headache.

• Severe itching.

• Significant weight loss.

• Not able to eat.

• Dark urine or yellow skin or eyes.

• Unable to pass urine.

• Very nervous and excitable.

• Any rash.

• No improvement in condition or feeling worse.

1. Thomas E. Brown, Ph.D., Attention Deficit Disorder: The Unfocused Mind in Children and Adults, (New Haven and London: Yale University Press, 2005): 265.
2. David Michelson, et al. “Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study,” Pediatrics 108, No. 5 (November 2001).
3. David Michelson, et al. “Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies,” Biological Psychiatry 52, no. 2: 112–120. doi: 10.1016/S0006–3223(02)0167-2
4. Thomas E. Brown, Ph.D., Attention Deficit Disorder: The Unfocused Mind in Children and Adults, (New Haven and London: Yale University Press, 2005): 265.
5. Carol Watkins, M.D. “Non-Stimulant Medications for Children, Adolescents and Adults with ADHD,” Northern County Psychiatric Associates, October 13, 2007, http://www.ncpamd.com/