Atomoxetine: Difference between revisions

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| generic = Atomoxetine

| brand = Strattera

| classes = NRI, ADHD medicine

| structure =

| mechanism = Selective norepinephrine reuptake ~~inhibitor~~

| classes = [[:Category:NRIs|Selective norepinephrine reuptake inhibitor (NRI)]], [[:Category:ADHD medicines|ADHD medicine]]

| uses = <vote slug="adhd-atomoxetine-use">Attention-deficit/hyperactivity disorder (FDA, ages 6+ and adult; the first non-controlled FDA-approved ADHD medicine)</vote>

| starting_dose = Children ≤70 kg: 0.5 mg/kg/day, titrate to 1.2 mg/kg/day after 3 days. Adults and children >70 kg: 40 mg PO once daily for 3 days, then 80 mg/day, then if needed 100 mg/day after 2-4 weeks

| preparations = Capsules 10, 18, 25, 40, 60, 80, 100 mg

| fda_max = 100 mg/day (adult); 1.4 mg/kg/day or 100 mg total (pediatric, whichever lower)

| pill_id =

| routes = Oral

| onset = ADHD effect emerges over 1-2 weeks (slower than psychostimulants); full effect 4-6 weeks

| duration = 24 hours (once-daily or split BID dosing)

| halflife = ~5 hours in extensive CYP2D6 metabolizers; ~21 hours in CYP2D6 poor metabolizers<ref name="strattera-label">FDA Prescribing Information, Strattera (atomoxetine hydrochloride), Eli Lilly, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021411s044lbl.pdf</ref>

| bioavailability = ~63% (oral; extensive first-pass)<ref name="strattera-label" />

| pregnancy = Limited human data.{{citation needed}}

| legal = [[USLegal:Prescription only|Rx-only]] in US. '''Not a controlled substance''', the principal clinical selling point versus psychostimulant ADHD options. Carries the antidepressant-class '''Boxed Warning''' for suicidal ideation in pediatric patients<ref name="strattera-label" />

| mechanism = <vote slug="atomoxetine-mech-claim">Selective inhibition of the presynaptic norepinephrine transporter (NET). Increases extracellular norepinephrine and, in the prefrontal cortex, dopamine (since prefrontal dopamine reuptake is largely NET-mediated in that region, accounting for the ADHD efficacy despite no direct dopamine targeting).</vote> '''Not a psychostimulant''': no euphoric or rewarding effect, no abuse liability, no Schedule classification. CYP2D6 substrate with a strong pharmacogenomic signal: poor metabolizers have approximately 5-10-fold higher plasma exposure than extensive metabolizers, and CPIC provides CYP2D6 dosing guidance<ref name="cpic-atomoxetine">CPIC Guideline for Atomoxetine and CYP2D6 Genotype, 2019. https://cpicpgx.org/guidelines/cpic-guideline-for-atomoxetine-based-on-cyp2d6-genotype/</ref>.

}}

~~[[Category:Antidepressants]]~~

== References ==

[[Category:NRIs]]

[[Category:ADHD medicines]]

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