TaperCommunityatomoxetine
Boxed Warning
Suicidality risk in children and adolescents. Severe liver injury reported (rare).
Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) used for the treatment of ADHD in children, adolescents, and adults. Unlike stimulant medications, it is not a controlled substance.
10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg
Capsules: 10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg
Category C (risk cannot be ruled out)
Selectively inhibits the presynaptic norepinephrine transporter (NET), increasing norepinephrine availability in the prefrontal cortex. Also increases dopamine in the prefrontal cortex (via NET-mediated dopamine reuptake in this region).
Selective norepinephrine reuptake inhibitor used for ADHD. Shorter half-life means withdrawal symptoms can appear quickly. Taper over 2–4 weeks minimum.
Not a controlled substance but discontinuation effects are reported. Reduce by 25% every 1–2 weeks. CYP2D6 poor metabolizers may need slower tapers due to longer effective half-life.
Toxicity
Hepatotoxicity (rare but serious — discontinue if jaundice or elevated liver enzymes). Cardiovascular effects (increased heart rate, blood pressure).
Pharmacokinetics
Rapidly absorbed, Tmax ~1–2 hours. Bioavailability 63% (94% in CYP2D6 poor metabolizers). May be taken with or without food.
0.85 L/kg
Hepatic via CYP2D6 (primary) to 4-hydroxyatomoxetine (active but low plasma levels). CYP2D6 poor metabolizers (~7% of Caucasians) have 5-fold higher AUC and 10-fold longer half-life.
Renal (>80% as metabolites, <3% unchanged).
98% (primarily albumin)
0.35 L/hr/kg (extensive metabolizers), 0.03 L/hr/kg (poor metabolizers)
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