Attention deficit hyperactivity disorder affects about 4% of adults and over 11% of children in the United States, making it one of the most common disorders. For many people living with ADHD, prescription drug therapy with medications such as atomoxetine is a key component of treatment, helping them address symptoms such as impulsiveness and difficulty with concentration.
There are two main types of ADHD medications, including stimulants and nonstimulants. Stimulants typically work by causing the brain to produce more chemicals such as dopamine, norepinephrine and serotonin, while nonstimulants work by slowing the breakdown of these chemicals. For many people, stimulants are more effective for treating ADHD, but they carry a higher risk of dependence and abuse. Nonstimulants, on the other hand, are considerably less likely to cause dependence.
Atomoxetine is a nonstimulant, making it a good option for many people who don’t tolerate stimulants well or have a history of substance abuse. Read on to learn more about atomoxetine, its uses and some things to consider before taking the medication.
Understanding Atomoxetine
Atomoxetine, which was approved by the FDA in 2002 and introduced to the market in 2003 as Strattera, became the first nonstimulant treatment specifically designed for ADHD. Today, it’s the most common nonstimulant medication prescribed to treat this condition. It comes in capsule form, and its dosage depends on the patient’s age and weight.
Atomoxetine is classified as a selective norepinephrine reuptake inhibitor, meaning that it helps manage ADHD by keeping more norepinephrine in the brain. Norepinephrine, which is both a hormone and a neurotransmitter, helps the body regulate how it responds to stress and mood changes, and it increases alertness, focus and the ability to retrieve memories.
In most cases, once norepinephrine does its job, the body breaks it down and it gets absorbed by the nerve cells. While scientists aren’t entirely sure how atomoxetine affects this process, the drug appears to block the cells from absorbing norepinephrine, causing it to stay in the brain for a longer period.
Uses and Benefits
Currently, the FDA only approves atomoxetine for the treatment of ADHD in children and adults. However, there’s some evidence that it’s effective in treating other conditions, and it’s sometimes prescribed off-label for these uses.
Some of the most common off-label uses include:
- Mood disorders
- Eating disorders
- Cognitive dysfunction
- Addiction treatment
Before using atomoxetine or any other medication off-label, it’s important to determine whether your health insurance company will cover the cost. Because insurance companies often consider off-label use to be “experimental” or “investigational,” you may be required to cover the entire cost out of pocket.
Risks and Side Effects
While atomoxetine doesn’t carry a risk of abuse or addiction for most people, that doesn’t mean it’s without a few side effects. The most common side effects include:
- Nausea
- Vomiting
- Upset stomach
- Constipation
- Dry mouth
- Loss of appetite
- Changes in mood or behavior
- Changes in sleep patterns
- Headaches
- Tiredness
- Dizziness
- Difficulty urinating
- Sexual problems
In addition to these, atomoxetine can have some more serious side effects, such as:
- Increased blood pressure
- Increased heart rate
- Heart attack
- Stroke
- Damage to the liver
- Slowed growth in height and weight in children
- Suicidal thoughts
- Signs of psychosis, including hallucinations
- Liver problems
- Behavioral changes, such as mania, hostility or aggressive behaviors
- Seizures
For the majority of people, this medication’s side effects are minor and typically go away once the body adapts to it. In some cases, a health provider may advise their patient to take two smaller doses of the medication, which can lessen side effects. In the event of more severe or life-threatening side effects, providers switch their patients to alternative treatment options. For those who experience chest pain, suicidal thoughts are trouble breathing, it’s important to seek prompt emergency care.
Precautions and Considerations
Atomoxetine is usually well-tolerated in adults and children over the age of 6, but your own medical history could impact this medication’s appropriateness for you. If you have preexisting jaundice or liver problems, you have a heart condition or you’ve been diagnosed with narrow angle glaucoma, atomoxetine may not be a good fit for treating your ADHD symptoms.
When you first start taking atomoxetine, you may experience tiredness or dizziness, which may make certain activities more dangerous. For that reason, your doctor may recommend that you not drive or operate heavy machinery until you understand how this medication affects you.
Additionally, if you’re managing depression or Parkinson’s disease with a monoamine oxidase inhibitor, or MAOI, atomoxetine can increase your risk of agitation, fever or coma. To avoid this interaction, you should wait at least two weeks after taking your final dose of an MAOI before you start on atomoxetine.
Dosage and Administration
For adults, the typical dosage of atomoxetine starts at 40 milligrams per day and is increased to 80 mg after three days. This seems to be the optimal dose for most people, but in some cases, a doctor may bump the dose up to 100 mg per day. Many people take their full dose in the morning, with or without food. Alternatively, some doctors have their patients take the daily amount in two doses, one in the morning and one in the late afternoon.
Note that it’s important to always take a full capsule, without breaking or crushing it. If you and your doctor think you would tolerate the medication better if it’s split into two doses, your doctor will prescribe accordingly.
Dosing for children works a little differently, as doctors consider their weight when determining the correct amount. For those who weigh less than 154 pounds (70 kilograms), the typical dosage starts at 0.5 mg per kg of body weight and tops out at 1.4 mg per kg of body weight, maxing out at 100 mg. For children who weigh more than 154 pounds, doctors usually follow the same guidelines for adult dosing. Similar to adults, children can take the full dose in the morning, or split it between the morning and evening, depending on their doctor’s recommendation.
You shouldn’t exceed the maximum recommended dose of 100 mg in a 24-hour period. If you accidentally miss a dose and don’t remember for several hours, skip that dose and take your next one on time. Don’t double up on medication to make up for the skipped dose.
Treatment Duration and Withdrawal
While atomoxetine can be effective in treating ADHD, it works much slower than stimulant alternatives. Someone who’s recently started taking the medication may not see a full improvement in their symptoms for up to six weeks. In fact, there’s research suggesting that the medication may not reach its maximum benefits for six to nine months for some patients. Even so, many people begin to notice a change in how they feel within the first couple of weeks.
The way people respond to atomoxetine varies. For some people, this medication adequately controls their ADHD symptoms, and they can stay on it long-term without issue. Others may need to switch to alternatives due to side effects or inadequate symptom control.
If you decide to stop taking atomoxetine, it’s important to first talk to your doctor. Most people can go off the medication easily without any side effects or withdrawal symptoms. However, this process can vary from person to person, and any changes to your medication regimen should only be done under a doctor’s supervision.
Conclusion
In many people, atomoxetine is an effective way to manage ADHD symptoms. While the medication doesn’t work quickly, with some patients staying on it for months before seeing a significant change, it can help individuals gain control over their lives and enjoy mental clarity. It has some side effects, but it’s an attractive option for those who are leery about taking a medication that carries a risk of dependence. Remember to talk to your doctor for personalized advice and to discuss any concerns you have with taking this or other ADHD medications.
