TaperCommunityatomoxetine
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.
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)
Selective inhibitor of the presynaptic norepinephrine transporter (NET), increasing synaptic norepinephrine. Minimal affinity for other neurotransmitter transporters or receptors.
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.
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. |
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
Practical insights shared by members tapering Strattera. Not medical advice — always consult your prescriber.
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
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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