Strattera Withdrawal & Tapering Guide
atomoxetine
Boxed Warning
Increased risk of suicidal ideation in children, adolescents, and young adults with ADHD or other psychiatric disorders. Monitor closely during initial therapy and dose changes.
In short
Strattera (atomoxetine) is an NRI with a half-life of ~5 hours (extensive metabolizers); ~21 hours (poor CYP2D6 metabolizers). Atomoxetine has a relatively short half-life and dose-dependent withdrawal is uncommon, but rebound ADHD symptoms, fatigue, and mood changes can occur. Withdrawal symptoms, when they occur, usually begin 1-3 days after dose reduction and settle within Most rebound symptoms resolve within 1-2 weeks.
- Class
- NRI
- Half-life
- ~5 hours (extensive metabolizers); ~21 hours (poor CYP2D6 metabolizers)
- Common doses
- 10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg
- Withdrawal onset
- 1-3 days after dose reduction
- Typical resolution
- Most rebound symptoms resolve within 1-2 weeks
Educational reference only. Dose changes are decided with the prescriber who knows your history.
Overview
Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. It is the first non-stimulant medication approved for ADHD.
10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg
Capsules: 10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg
Category C (risk cannot be ruled out)
Mechanism of Action
Selective inhibitor of the presynaptic norepinephrine transporter (NET), increasing synaptic norepinephrine. Minimal affinity for other neurotransmitter transporters or receptors.
Taper Notes
Atomoxetine has a relatively short half-life and dose-dependent withdrawal is uncommon, but rebound ADHD symptoms, fatigue, and mood changes can occur. Step down by available capsule strengths.
Hyperbolic Tapering Guidance
Atomoxetine is generally easier to discontinue than SSRIs because dependence is uncommon, but stepwise reductions matched to capsule strengths help blunt rebound symptoms. CYP2D6 poor metabolizers may experience prolonged effects and should taper more slowly.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Tapering Protocol
Evidence-based phased reduction schedule. Always taper under medical supervision.
| Phase | Duration | Notes |
|---|---|---|
| Initial reductions | 2-3 weeks | Step down using available capsule strengths (e.g., 80 → 60 → 40mg). Most extensive metabolizers tolerate larger early steps. |
| Middle reductions | 2-3 weeks | Continue stepwise reductions. Monitor for rebound ADHD symptoms and mood changes. |
| Final reductions | 2-4 weeks | Lowest capsule (10mg) to off. Poor CYP2D6 metabolizers may benefit from longer holds at this stage. |
Withdrawal Timeline
1-3 days after dose reduction
3-7 days
Most rebound symptoms resolve within 1-2 weeks
Rebound ADHD symptoms and low mood may persist 2-4 weeks; uncommon beyond that
Community Tips
Practical insights shared by members tapering Strattera. Not medical advice — always consult your prescriber.
- 1Atomoxetine is generally easier to come off than SSRIs — most members find a 2-4 week stepdown by capsule strength sufficient.
- 2If you are a known CYP2D6 poor metabolizer or take a strong CYP2D6 inhibitor (paroxetine, fluoxetine), expect a slower clearance and plan a longer taper.
- 3Watch for rebound focus and mood difficulties — these mimic untreated ADHD but typically resolve within a couple of weeks.
- 4Splitting the daily dose to twice daily before stepping down can soften the transition for some members.
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- MAOIs — contraindicated within 14 days (hypertensive crisis risk)
- Strong CYP2D6 inhibitors (paroxetine, fluoxetine, quinidine) markedly increase exposure
- Albuterol and other beta-agonists may potentiate cardiovascular effects
Food Interactions
- No clinically significant food effect on AUC
- Food may reduce nausea associated with the morning dose
Contraindications
- Concurrent or recent (within 14 days) MAOI use
- Narrow-angle glaucoma
- Pheochromocytoma
Toxicity
Suicidal ideation in pediatric patients, severe hepatic injury (rare), and increased blood pressure/heart rate. Risk of QT prolongation in poor metabolizers or with CYP2D6 inhibitors.
Pharmacokinetics
ADME Profile
Rapidly absorbed after oral administration, Tmax 1–2 hours. Bioavailability 63% in extensive metabolizers, 94% in poor metabolizers. Food may delay Tmax but does not affect overall exposure.
~0.85 L/kg
Extensive hepatic metabolism, primarily via CYP2D6 to 4-hydroxyatomoxetine (active, but rapidly glucuronidated). Minor contributions from CYP2C19.
Renal (>80% as conjugated 4-hydroxyatomoxetine), <3% unchanged.
~98% (primarily albumin)
~0.35 L/h/kg (extensive metabolizers); ~0.03 L/h/kg (poor metabolizers)
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Other Drug Profiles
The arithmetic of a proportional reduction
The Maudsley Deprescribing Guidelines and NICE NG222 describe reducing NRI medications by a proportion of the previous dose rather than by a fixed amount, so each cut is smaller than the last. The table shows what that arithmetic produces at 10% per step, using 40 mg only as a worked example. How large each step is, how long it is held, and whether this pattern applies at all are decisions for the person and their prescriber.
| Step | % of starting dose | Worked example (40 mg start) |
|---|---|---|
| Start | 100% | 40 mg |
| Step 1 | 90% | 36 mg |
| Step 2 | 81% | 32.4 mg |
| Step 3 | 73% | 29.2 mg |
| Step 4 | 66% | 26.2 mg |
| Step 5 | 59% | 23.6 mg |
| Step 6 | 53% | 21.3 mg |
| Step 7 | 48% | 19.1 mg |
| Step 8 | 43% | 17.2 mg |
This is an illustration of a published method, not a schedule for anyone. It does not account for how long you have taken Strattera, your current dose, formulation, or history. TaperCommunity does not recommend doses or dose changes; those are agreed with your prescriber.
Frequently asked questions about Strattera
What are the withdrawal symptoms of Strattera (atomoxetine)?
Common withdrawal symptoms of Strattera (atomoxetine) include: rebound ADHD symptoms, fatigue, irritability, low mood, sleep changes, difficulty concentrating. Symptom severity varies by individual, dose, and duration of use.
How should I taper off Strattera (atomoxetine)?
Atomoxetine has a relatively short half-life and dose-dependent withdrawal is uncommon, but rebound ADHD symptoms, fatigue, and mood changes can occur. Step down by available capsule strengths. Atomoxetine is generally easier to discontinue than SSRIs because dependence is uncommon, but stepwise reductions matched to capsule strengths help blunt rebound symptoms. CYP2D6 poor metabolizers may experience prolonged effects and should taper more slowly.
How long does Strattera withdrawal last?
Strattera withdrawal typically begins 1-3 days after dose reduction, peaks around 3-7 days, and resolves within Most rebound symptoms resolve within 1-2 weeks. Rebound ADHD symptoms and low mood may persist 2-4 weeks; uncommon beyond that
Can I stop Strattera cold turkey?
Stopping Strattera abruptly is not recommended. Its half-life is ~5 hours (extensive metabolizers); ~21 hours (poor CYP2D6 metabolizers), and the receptor adaptations built up during treatment do not reverse at that speed, so a sudden stop tends to produce the sharpest withdrawal. Prescribing guidance favours gradual, proportional reductions agreed with your prescriber.
How long does Strattera stay in your system?
Strattera (atomoxetine) has a half-life of ~5 hours (extensive metabolizers); ~21 hours (poor CYP2D6 metabolizers). As a rule of thumb, a drug is mostly cleared after about five half-lives. Withdrawal symptoms often begin before the drug has fully cleared and continue after it has, because the adaptations the brain made during treatment reverse more slowly than the drug leaves the blood.
What tips do others have for tapering Strattera?
Atomoxetine is generally easier to come off than SSRIs — most members find a 2-4 week stepdown by capsule strength sufficient. If you are a known CYP2D6 poor metabolizer or take a strong CYP2D6 inhibitor (paroxetine, fluoxetine), expect a slower clearance and plan a longer taper. Watch for rebound focus and mood difficulties — these mimic untreated ADHD but typically resolve within a couple of weeks. Splitting the daily dose to twice daily before stepping down can soften the transition for some members.
Sources & References
Strattera (atomoxetine) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Regulatory sources
Official prescribing information and safety notices.
Peer-reviewed research
Primary literature cited in this taper guide.
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
- Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)
- Framer A 2021 — The patient voice: an exploration of the experience of withdrawal from antidepressants (Therapeutic Advances in Psychopharmacology)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.