Strattera

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 is not a controlled substance, offering a distinct pharmacological profile with a lower abuse potential. Its mechanism centers on increasing norepinephrine in the prefrontal cortex, a key region for executive functions like attention, impulse control, and organization. This provides a foundational approach to managing core ADHD symptoms throughout the day.

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
• Dosing Regimen: Typically once or twice daily, with or without food
• Onset of Action: Therapeutic effects may take 2–4 weeks to become fully apparent
• Controlled Substance Status: Not a controlled substance; no known abuse potential

Benefits

• Provides 24-hour symptom control from a single daily dose, supporting consistent performance at school, work, and home
• Reduces core ADHD symptoms including inattention, hyperactivity, and impulsivity without stimulant-related side effects
• Non-addictive profile eliminates concerns regarding misuse, dependence, or diversion
• May improve emotional regulation and reduce rejection sensitive dysphoria (RSD) in some individuals
• Suitable for patients with comorbid anxiety or tic disorders, where stimulants may be contraindicated
• Does not cause insomnia or appetite suppression to the same degree as traditional stimulants

Common use

Strattera is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in patients aged 6 years and older. It is used to reduce symptoms such as difficulty sustaining attention, hyperactivity, impulsive behavior, and poor organizational skills. It may be selected for patients who have not responded adequately to stimulant medications, those with a history of substance use disorder, or individuals who experience significant adverse effects from stimulants. It is also used in cases where once-daily dosing is preferred for adherence.

Dosage and direction

Dosing is based on body weight for patients under 70 kg. Therapy is initiated at approximately 0.5 mg/kg per day, with increases after a minimum of 3 days to a target daily dose of approximately 1.2 mg/kg. Maximum recommended daily dose is 1.4 mg/kg or 100 mg, whichever is less. For patients over 70 kg, start at 40 mg daily and increase after a minimum of 3 days to a target dose of 80 mg daily. May be administered as a single daily dose in the morning or divided into two doses (morning and late afternoon/early evening). Capsules should be swallowed whole and not opened.

Precautions

Monitor for the emergence of agitation, irritability, suicidal thinking, or unusual changes in behavior, particularly during the initial months of therapy or after dose changes. Blood pressure and heart rate should be monitored at baseline and periodically during treatment. 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. May affect urinary outflow; caution advised in patients with urinary retention. Not recommended in patients with narrow-angle glaucoma.

Contraindications

Hypersensitivity to atomoxetine or any component of the formulation. Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 2 weeks of discontinuing MAOIs due to risk of serotonin syndrome. Patients with narrow-angle glaucoma. Severe cardiovascular disorders that might be exacerbated by increases in blood pressure or heart rate.

Possible side effect

Common side effects include: nausea, dry mouth, insomnia, fatigue, decreased appetite, constipation, dizziness, sweating, and mood swings. Less common but serious side effects may include: suicidal ideation (especially in children and adolescents), severe liver injury, angioedema, urticaria, priapism (prolonged and painful erection), orthostatic hypotension and syncope, and Raynaud’s phenomenon. Slowed growth (height and weight) has been observed in children with long-term use.

Drug interaction

Contraindicated with MAOIs. May interact with drugs that inhibit CYP2D6 (e.g., paroxetine, fluoxetine, quinidine) resulting in increased atomoxetine levels. Concomitant use with albuterol or other beta-agonists may potentiate cardiovascular effects. Use with pressor agents may result in additive effects on blood pressure. Avoid with drugs that increase norepinephrine.

Missed dose

If a dose is missed, it should be taken as soon as possible 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.

Overdose

Symptoms may include somnolence, agitation, hyperactivity, abnormal behavior, gastrointestinal symptoms, and signs of sympathetic nervous system excitation such as tachycardia, dry mouth, and mydriasis. There is no specific antidote. Provide supportive care and monitor cardiac function. Gastric lavage and activated charcoal may be considered.

Storage

Store at room temperature (20°C to 25°C/68°F to 77°F); excursions permitted between 15°C–30°C (59°F–86°F). Keep in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Do not disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

Clinical trials and post-marketing studies demonstrate Strattera’s efficacy in reducing ADHD symptoms with a favorable non-stimulant profile. Many patients and clinicians report improved focus and behavioral control without the “ups and downs” associated with stimulants. Drawbacks include a slower onset of action and gastrointestinal side effects during titration. It is widely regarded as a valuable option, especially for those who cannot or prefer not to use stimulant medications.