Atomoxetine

SNRI (Non-stimulant)·Psychiatry - ADHD & Stimulants

Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents, and adults

Authority requiredPBSNON-STIMULANTStrattera100 mg+2

Max Dose

100 mg/day

Half-life

5-24 h

Hepatotoxicity

RARE RISK

Onset

2-4 WEEKS

Rapid Summary

Overview

Non-stimulant Noradrenaline Reuptake Inhibitor (NRI). Used for ADHD. Zero abuse potential. Highly effective but takes weeks to work, unlike instant stimulants.

Maximum Dose

Max 100 mg/day (or 1.2 mg/kg/day in children).

Clinical Focus

Carries a rare black box warning for severe hepatotoxicity and increased suicidal ideation in children.

Bottom Line

Atomoxetine is a non-stimulant option for ADHD without abuse potential, but takes 4-6 weeks for full effect and carries a rare risk of suicidal ideation in young people.

Formulation & Access

Brand Names

Strattera

Oral Routes

Capsules (10, 18, 25, 40, 60, 80, 100 mg). Do NOT open the capsule (powder is a severe ocular irritant).

Prescribing & PBS

Authority Required (PBS). Unrestricted S4 (Not an S8 controlled drug).

Indications & Use

Primary

PBSTGA

Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents, and adults.

Clinical Place

The drug of choice for ADHD patients who have a history of substance abuse, severe anxiety/tics (which stimulants worsen), or those who cannot tolerate the stimulant 'crash'.

Quick reference

Class & Role

SNRI (Non-stimulant) — Non-stimulant Noradrenaline Reuptake Inhibitor (NRI).

Route / Formulation

Capsules (10, 18, 25, 40, 60, 80, 100 mg). Do NOT open the capsule (powder is a severe ocular irritant). (Strattera)

Usual Dose & Max

Start PO 40 mg OD (morning). Titrate after 3 days to target 80 mg/day. Max 100 mg/day.

Key Indication Doses

ADHD (Adults & Children > 70kg): Start PO 40 mg OD (morning). Titrate after 3 days to target 80 mg/day. Max 100 mg/day. ADHD (Children < 70kg): Start PO 0.5 mg/kg OD. Target 1.2 mg/kg/day. Hepatic Impairment: Halve the dose in moderate hepatic impairment. Avoid in severe.

Best Uses

Atomoxetine is a non-stimulant option for ADHD without abuse potential, but takes 4-6 weeks for full effect and carries a rare risk of suicidal ideation in young people.

Avoid / Cautions

Concurrent MAOI use, narrow-angle glaucoma, severe cardiovascular disease, pheochromocytoma. Pregnancy Category B3.

Key Risks

Hepatic: Severe idiosyncratic hepatotoxicity/liver failure (rare, but potentially fatal). Psychiatric: Increased suicidal ideation in children/adolescents during the first month. Somnolence, fatigue. Cardiovascular: Tachycardia, hypertension (due to noradrenaline boost). Gastrointestinal: Nausea, vomiting, severe anorexia/weight loss.

Key Interactions

Strong CYP2D6 inhibitors (Fluoxetine, Paroxetine) massively spike Atomoxetine levels. Max dose must be capped at 80 mg/day (or much lower in children) if combined. MAOIs (Fatal hypertensive crisis).

Monitoring

Warn parents/patients to stop the drug and present to ED instantly if yellow eyes, dark urine, or severe right-upper quadrant pain develops (Liver failure). Baseline BP, HR, Weight, and Height (in kids).

Clinical Pearl

Patients who switch from Dexamphetamine to Atomoxetine often complain 'it does nothing'. You must counsel them that stimulants work in 30 minutes, but Atomoxetine takes 4 weeks to kick in. They must be patient.

Access

Authority requiredStrattera100 mg

Brand: Strattera
PBS status: Authority required
Formulation: Capsules (10, 18, 25, 40, 60, 80, 100 mg)

Atomoxetine

SNRI (Non-stimulant)·Psychiatry - ADHD & Stimulants

Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents, and adults

Authority requiredPBSNON-STIMULANTStrattera100 mg+2

Max Dose

100 mg/day

Half-life

5-24 h

Hepatotoxicity

RARE RISK

Onset

2-4 WEEKS

Rapid Summary

Overview

Non-stimulant Noradrenaline Reuptake Inhibitor (NRI). Used for ADHD. Zero abuse potential. Highly effective but takes weeks to work, unlike instant stimulants.

Maximum Dose

Max 100 mg/day (or 1.2 mg/kg/day in children).

Clinical Focus

Carries a rare black box warning for severe hepatotoxicity and increased suicidal ideation in children.

Bottom Line

Atomoxetine is a non-stimulant option for ADHD without abuse potential, but takes 4-6 weeks for full effect and carries a rare risk of suicidal ideation in young people.

Formulation & Access

Brand Names

Strattera

Oral Routes

Capsules (10, 18, 25, 40, 60, 80, 100 mg). Do NOT open the capsule (powder is a severe ocular irritant).

Prescribing & PBS

Authority Required (PBS). Unrestricted S4 (Not an S8 controlled drug).

Indications & Use

Primary

PBSTGA

Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents, and adults.

Clinical Place

The drug of choice for ADHD patients who have a history of substance abuse, severe anxiety/tics (which stimulants worsen), or those who cannot tolerate the stimulant 'crash'.

Quick reference

Class & Role

SNRI (Non-stimulant) — Non-stimulant Noradrenaline Reuptake Inhibitor (NRI).

Route / Formulation

Capsules (10, 18, 25, 40, 60, 80, 100 mg). Do NOT open the capsule (powder is a severe ocular irritant). (Strattera)

Usual Dose & Max

Start PO 40 mg OD (morning). Titrate after 3 days to target 80 mg/day. Max 100 mg/day.

Key Indication Doses

Best Uses

Atomoxetine is a non-stimulant option for ADHD without abuse potential, but takes 4-6 weeks for full effect and carries a rare risk of suicidal ideation in young people.

Avoid / Cautions

Concurrent MAOI use, narrow-angle glaucoma, severe cardiovascular disease, pheochromocytoma. Pregnancy Category B3.

Key Risks

Key Interactions

Strong CYP2D6 inhibitors (Fluoxetine, Paroxetine) massively spike Atomoxetine levels. Max dose must be capped at 80 mg/day (or much lower in children) if combined. MAOIs (Fatal hypertensive crisis).

Monitoring

Clinical Pearl

Access

Authority requiredStrattera100 mg

Brand: Strattera
PBS status: Authority required
Formulation: Capsules (10, 18, 25, 40, 60, 80, 100 mg)