Atomoxetine (Strattera)

Mechanism of action

Selective norepinephrine reuptake inhibitor (NRI) — blocks the norepinephrine transporter, increasing extracellular norepinephrine. The selectivity for norepinephrine over dopamine produces ADHD benefit without the abuse liability of stimulants. Effects build over 2-4 weeks rather than acute action.

History

Atomoxetine was approved by the FDA in 2002 as the first non-stimulant ADHD medication. The non-stimulant mechanism made it appealing for users with stimulant abuse concerns, comorbid anxiety, or cardiovascular contraindications. Long-term tolerability is generally good but the effect size is smaller than stimulants. Prescription required globally.

Benefits

• ADHD symptoms

  EVIDENCEA

  Multiple RCTs.

• No abuse potential

  EVIDENCEA

  Mechanism + clinical experience.

Side effects

• Insomniacommonmoderate
• Decreased appetitecommonmoderate
• Liver injury (rare)raresevere

Cited research

• Atomoxetine for adult ADHD: meta-analysis (Asherson)2014
  PMID 24745390 ↗
• Atomoxetine vs stimulants in pediatric ADHD: comparison (Schwartz)2010
  PMID 21073325 ↗
• Atomoxetine pharmacology review (Sauer)2005
  PMID 16188022 ↗

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