Atomoxetine

Selective norepinephrine reuptake inhibitor (NRI), ADHD medicine

Atomoxetine

Strattera

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Summary

Classes

Selective norepinephrine reuptake inhibitor (NRI), ADHD medicine

Common uses

Attention-deficit/hyperactivity disorder (FDA, ages 6+ and adult; the first non-controlled FDA-approved ADHD medicine)▲0▼

Pharmacy

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

US FDA Max

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

Pharmacology

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)

Half-life

~5 hours in extensive CYP2D6 metabolizers; ~21 hours in CYP2D6 poor metabolizers

Bioavailability

~63% (oral; extensive first-pass)

Pregnancy

Limited human data.^{[citation needed]}

Legal status

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

Purported mechanism

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).▲0▼ 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.