Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor (NRI) approved for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents, and adults. As the first non-stimulant medication approved by the FDA for ADHD management, it offers a distinct pharmacological profile, providing an alternative for patients who may not tolerate or have contraindications to stimulant-based therapies. Its mechanism of action focuses on increasing norepinephrine in the prefrontal cortex, a key area for executive functions like attention, impulse control, and organization, leading to measurable improvements in daily functioning.

Features

• Active Ingredient: Atomoxetine hydrochloride.
• Pharmacological Class: Selective norepinephrine reuptake inhibitor (NRI).
• Available Formulations: Capsules available in multiple strengths: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg.
• Dosing Regimen: Typically administered once or twice daily, with or without food.
• Prescription Status: Available by prescription only; not a controlled substance (Schedule II).
• Onset of Action: Therapeutic effects may take 2 to 4 weeks to become fully apparent.
• Manufacturer: Eli Lilly and Company.

Benefits

• Provides 24-hour symptom control from a single daily dose, supporting consistent performance at school, work, and in social settings.
• Reduces core ADHD symptoms, including inattention, hyperactivity, and impulsivity, without the potential for abuse or dependence associated with stimulants.
• Improves executive functioning, leading to better task completion, organizational skills, and overall quality of life.
• Suitable for patients with comorbid anxiety or tic disorders, where stimulants may be contraindicated or poorly tolerated.
• May be used in patients with a history of substance use disorder, offering a safer pharmacological profile.
• Demonstrated efficacy in both pediatric and adult populations, supporting long-term management strategies.

Common use

Strattera is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in patients aged 6 years and older, including adults. It is used to reduce symptoms of inattention, hyperactivity, and impulsivity that interfere with social, academic, and occupational functioning. It may be selected as a first-line treatment for patients who cannot or prefer not to use stimulant medications, or for those with specific comorbidities such as anxiety disorders or a history of substance abuse. It is also utilized in cases where once-daily dosing is preferred for adherence.

Dosage and direction

Dosing of Strattera must be individualized based on patient weight (for children and adolescents), therapeutic response, and tolerability. For children and adolescents up to 70 kg body weight, the initial dose is approximately 0.5 mg/kg/day, which may be increased after a minimum of 3 days to a target daily dose of approximately 1.2 mg/kg/day. The maximum recommended daily dose is 1.4 mg/kg/day or 100 mg, whichever is less. For patients over 70 kg and adults, the initial dose is 40 mg daily, which may be increased after a minimum of 3 days to a target dose of 80 mg daily. The maximum recommended daily dose for adults is 100 mg. Administration may be once daily in the morning or divided into two doses (morning and late afternoon/early evening). Capsules should be swallowed whole and must not be opened, chewed, or crushed.

Precautions

Patients should be monitored for the emergence or worsening of aggression, hostility, or suicidal ideation, especially during initial treatment and dose adjustments. Regular assessment of heart rate and blood pressure is advised, as atomoxetine can cause increases in both. Use with caution in patients with cardiovascular disease, hypertension, tachycardia, or cerebrovascular disorders. Hepatic function should be evaluated in patients with symptoms of liver injury (e.g., jaundice, dark urine). Patients with narrow-angle glaucoma should avoid Strattera due to increased risk of pupil dilation. Caution is advised in patients with urinary retention or hesitancy. Pregnancy and breastfeeding considerations should be discussed, as safety data are limited.

Contraindications

Strattera is contraindicated in patients with known hypersensitivity to atomoxetine or any component of the formulation. It should not be used concurrently with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome or hypertensive crisis. It is also contraindicated in patients with narrow-angle glaucoma and severe cardiovascular disorders where increases in blood pressure or heart rate would be problematic.

Possible side effect

Common side effects may include decreased appetite, nausea, vomiting, fatigue, dizziness, and mood swings. Dry mouth, constipation, and insomnia have also been reported. Less frequently, patients may experience orthostatic hypotension, urinary retention, or sexual side effects such as erectile dysfunction. Severe but rare adverse effects include hepatotoxicity, suicidal ideation (particularly in children and adolescents), severe cardiovascular events (e.g., hypertension, tachycardia), and allergic reactions such as angioedema. Priapism, though very rare, requires immediate medical attention.

Drug interaction

Strattera is primarily metabolized by CYP2D6; concomitant use with strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine) may increase atomoxetine levels and necessitate dose adjustment. Avoid use with MAOIs due to risk of serious reactions. Use cautiously with drugs that increase blood pressure or heart rate (e.g., albuterol, decongestants). Potential pharmacodynamic interactions may occur with other noradrenergic agents. Concomitant use with stimulants is not recommended without careful supervision.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed one is not recommended.

Overdose

Symptoms of overdose may include drowsiness, agitation, hyperactivity, abnormal behavior, gastrointestinal symptoms (e.g., nausea, vomiting), tachycardia, hypertension, and mydriasis. Severe overdose may lead to seizures or QT prolongation. There is no specific antidote; management involves symptomatic and supportive care, including monitoring of vital signs and ECG. Gastric lavage or activated charcoal may be considered if ingestion was recent.

Storage

Store at room temperature (15–30°C or 59–86°F) in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Individual patient needs and responses may vary.

Reviews

Clinical trials and post-marketing studies have demonstrated Strattera’s efficacy in reducing ADHD symptoms with a favorable non-stimulant profile. Many patients and clinicians report improved focus, reduced impulsivity, and better daily functioning. However, response can be variable; some patients may not achieve desired symptom control or may experience side effects that limit use. Long-term adherence is often supported by its non-controlled status and once-daily dosing convenience.