Atomoxetine

Medication name

Atomoxetine ("A-tom-OX-et-een")
Brand name

Strattera® ("Strat-AIR-a")
Medication type

Noradrenaline reuptake inhibitor

Capsules: 10mg, 18mg, 25mg, 40mg, 60mg, 80mg, and 100mg strengths

Oral solution: 4mg in 1ml

If you are aged six or over, the doctor can prescribe atomoxetine for you as a licensed medicine to help control the symptoms of attention deficit hyperactivity disorder (ADHD).

Read our guide to ADHD and mental health

About atomoxetine

Atomoxetine is a noradrenaline reuptake inhibitor.

It is not a central nervous stimulant, which makes it different from other treatments for attention deficit hyperactivity disorder (ADHD). Instead, it makes more noradrenaline available in your brain.

Noradrenaline (also known as norepinephrine) is a chemical released from nerve endings to carry messages from one nerve cell to another in the brain. After sending the message, noradrenaline is taken back up by the nerve endings in a recycling process. Atomoxetine is a molecule that stops this process. This means that the levels of active noradrenaline in the brain increase.

Higher levels of noradrenaline in the brain help to make people more alert and ready for action. They feel like they have increased wellbeing and more energy.

It should help to increase your attention span and your concentration, and stop you acting on impulse without thinking.
Outside of the brain, higher levels of noradrenaline have other effects in different parts of the body, including the heart, the gut and the lungs. This can lead to unwanted side effects. It is hard to predict if and how you will be affected as each person is different.

Atomoxetine and everyday life

Your doctor will start you on a low dose for a week before gradually increasing it to the right treatment dose for you. If you are under 18, your weight will be used to calculate your dose.

You will normally start to feel some benefits in the first week of treatment, but it can take eight to 12 weeks for the full effects to be reached. You may get additional benefits if you continue to take it longer.

If you are already taking a central nervous system stimulant like methylphenidate, your doctor may advise you to overlap this with atomoxetine for a few weeks as you switch treatments. This lets the atomoxetine build up in your system and have the chance to start working before you stop the stimulant.

Some young people have experienced growth delay in weight and height when they start to take atomoxetine. This has been linked to having a lower appetite – a side effect of the medicine. Over time, most of these young people have caught up with their peers.

Make sure that you get your height and weight checked before you start taking atomoxetine, and at regular intervals while you are taking it.

Sometimes the doctor might stop the medicine or change the dose for a while to let you catch up on weight and height, and then start it again.

Talk to your doctor or pharmacist if you are concerned about your weight, or changes to your weight, while taking atomoxetine.

A very common side effect of atomoxetine is a dry mouth. Over a long time, this can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking atomoxetine so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Atomoxetine can make you feel tired and sleepy.
It has also made some people find it difficult to get to sleep and stay asleep. Some people also wake up early in the morning and are unable to get back to sleep.

If you think your medicine is making your sleep worse, or if you feel sleepy and tired all the time and this doesn’t improve with time, go back to your doctor and discuss what changes could be made to help. This may include switching the timing of the dose or changing to a different medication.

Alcohol

It may be possible to drink some alcohol in moderation while taking atomoxetine, but having the two together might make you very sleepy.
During the first week and when your dose is increased it might be best to stop drinking alcohol until you see how the medicine affects you.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

We do not have any information about using atomoxetine with drugs as not enough research has been carried out. There may be some reactions if you mix it with drugs, which could be dangerous, but we do not know what they are.

It is advisable to avoid the use of street drugs or ‘legal highs’. There is no regulation of these, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on drugs and alcohol.

Atomoxetine does not mix well with some other medicines, including herbal remedies. If you are taking other medicines, atomoxetine may affect how well they work or may cause side effects. Tell your doctor about these before you start your treatment.

Some medicines can slow down how quickly atomoxetine is removed from the body, and your doctor may need to adjust the dose of your medication if they are taken together.
Talk to your pharmacist if you buy any medications over the counter to treat common illnesses like colds and flu, or medications that you put on your skin.

You should not take atomoxetine if you have taken a medicine known as a monoamine oxidase inhibitor (MAOI) antidepressant like phenelzine, isocarboxazid, tranylcypromine or moclobemide in the last two weeks.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with atomoxetine. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

Atomoxetine capsules contain gelatine. If you need to avoid animal products such as gelatine, please note that this is often found in capsules but also in some tablet formulations. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

You can also take atomoxetine as a liquid. The oral solution contains sorbitol and anyone with hereditary fructose intolerance should not take this. It also contains sucralose, but this should not affect your blood sugars if you are diabetic.

There are several companies that manufacture this medicine and the non-active ingredients are likely to vary between products.
Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

Do not drive a car or ride a bike just after you start taking atomoxetine.

Taking atomoxetine may make you feel tired or dizzy when you first start treatment. This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days until you know how it affects you.

Most people drive as normal while taking atomoxetine. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

You must tell DVLA if your ADHD or your ADHD medication affects your ability to drive safely. This is not necessary if your condition or medication doesn’t affect your ability to drive safely. Ask your doctor if you’re not sure.

Pregnancy

If you become pregnant while you are on atomoxetine, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing atomoxetine and help you to make a decision that is best for you and your baby. They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking atomoxetine during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with atomoxetine.

Breastfeeding

We know that atomoxetine passes into breastmilk. It is unlikely that a significant amount passes into breastmilk but the exact amounts are not clear. Currently, we don’t have much information about taking atomoxetine whilst breastfeeding.

If your baby was born early or has health problems, then breastfeeding while you are taking atomoxetine may not be recommended.
If you breastfeed while taking atomoxetine, seek urgent medical advice if your baby becomes restless, very sleepy, or develops feeding problems.

If your medication makes you sleepy, do not to sleep with your baby in the same bed, and be cautious when handling your baby (especially if waking during the night for feeds).

Talk to your midwife, doctor or pharmacist if you want to breastfeed while taking atomoxetine. They will help you to weigh up the benefits and possible risks based on what we currently know so you can make a decision that is best for you and your baby.

Sex

Atomoxetine can have side effects that may affect your sex life, including:

problems with getting an erection (getting hard) and ejaculating (coming)
difficulty reaching orgasm (coming) the same way as before or not being able to have an orgasm at all
feeling too tired to have sex
pain in the penis and/or testicles

Another rare side effect that has been reported is a long-lasting and painful erection (called priapism). If this happens, you will need to be treated in hospital.

Most side effects occur when you first start medication and improve over time. If they do not, and this is a problem for you, make an appointment to discuss this with your doctor.

If it works for you, atomoxetine may have a positive effect on your sex life as your symptoms settle, and you can concentrate on your relationships.

Fertility

We do not have enough information to know if there are effects on fertility, but it is thought to be unlikely.

An uncommonly reported side effect of atomoxetine is irregular periods. This may make it harder if you are planning a pregnancy. Talk to your doctor about your atomoxetine if you are trying to get pregnant.

Atomoxetine is not a banned substance in sport.

Most people play sports as normal while taking atomoxetine. However, you may feel tired or dizzy at first which may cause a problem in sports where you need a lot of focus. It might be best to stop doing those sports for a short time until you know how the medicine affects you.

If you are worried that taking atomoxetine might make doing the sports you enjoy more difficult, discuss this with your doctor.

Ideally it is best not to take atomoxetine for the first time just before your exams.

It is not possible to predict how the medication will make you feel, and if you do get any side effects, like feeling dizzy or tired, these are more likely to occur when you first start taking it.

You should talk to your doctor about any future exams if you are starting atomoxetine. You might decide together to delay starting it until you have done them. If they are more than a month away, however, you might find that it is better to start atomoxetine to improve your motivation and ability to study.

If it works for you, atomoxetine should improve your concentration and ability to focus, so you may find it will help you to study. If you are worried that taking atomoxetine might make studying for or taking your exams harder, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking atomoxetine

If this medicine helps you, it is likely that you will take it for several years or more. If you start this medicine when you are under 18, it may still help you when you are an adult.

Your specialist doctor should review your treatment regularly with you (at least once a year) and discuss whether you think the medicine is still helping you.

You and your doctor may agree to try a break in treatment to see how you feel. This can help you to decide whether it would be best to continue with your medicine or not.

You will get the best effect from atomoxetine if you take it every day at the dose prescribed by your doctor.

You may have to take atomoxetine once or twice a day.

Take one dose in the morning at breakfast time. If you need to take this medicine twice a day, you can take another dose in the later afternoon or early evening. If you take it later in the evening, you might find it harder to get to sleep.

Swallow the capsule with some water, without chewing it. It does not matter if you take it before or after food.

Do not open the capsule to take out the powder as it can irritate your eyes. If you accidentally split a capsule, you should wash your hands thoroughly. If the powder does get into your eyes, wash them out with water and see a doctor as soon as possible.

Atomoxetine liquid will be provided with an oral syringe so you can measure the dose you need accurately. This can be taken with or without food.

If you forget to take a dose, then just take it as soon as possible, unless it is getting close to your next dose.

If you usually take a dose in the afternoon or evening as well, just take the next dose when it is due.

If you forget to take it by the evening, just start again the next day. Do not try to catch up by taking a double dose.

If you forget to take your medicine for a few days, your symptoms may come back.

Once you start taking atomoxetine, the brain adjusts to having a new level of noradrenaline around. If you stop taking atomoxetine all at once, the balance starts to change again.

There are no reported withdrawal effects if you stop atomoxetine suddenly, but you could get your old symptoms back.

If you do not want to take this medicine anymore, it is important that you talk to your doctor about this.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

upset stomach and gut
sleepiness
dizziness
shaking
unusual behaviour

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Suicidal thoughts

While uncommon, atomoxetine can sometimes cause you to have thoughts about hurting yourself or taking your own life. If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Read our guide to suicidal feelings

Serious side effects

Atomoxetine may cause rare but serious side effects, including allergic reactions.

Stop taking atomoxetine and go to a hospital straight away if you get any of the following symptoms:

difficulty breathing
an allergic reaction or allergy (including symptoms such as swelling of your face, eyelids, lips, tongue or throat so that you cannot swallow or breathe, or really bad itching of the skin with raised lumps)
fast, uneven heartbeat and fainting (this could mean a life-threatening condition called Torsades de Pointes)
you start having seizures or fits for the first time
a painful erection (priapism) that lasts for more than three hours

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking atomoxetine, if you get any of the following symptoms:

feeling aggressive, angry or hostile
having mood swings or mood changes
psychotic symptoms including hallucinations (hearing voices or seeing things which are not there), believing things that are not true, or being extra suspicious
pain in your stomach or gut which is sore if you press it on the right side, just under your ribs
feeling sick for no obvious reason
generally feeling unwell – feeling tired, or like you are getting flu
itching
your wee is darker in colour than usual
jaundice (your skin or the whites of your eyes start to look a bit yellow)

Atomoxetine can affect how the liver works. If you have stomach pains, feel sick or generally unwell, lose your appetite or notice your skin or eyes start to look yellow, then see your doctor straight away.

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking atomoxetine. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor or pharmacist about them.

Very common side effects of atomoxetine, affecting more than one in ten people, include:

stomach or gut pain/feeling or being sick
loss of appetite
faster pulse rate
dry mouth
feeling sick

Common side effects of atomoxetine, affecting up to one in ten people include:

feeling irritable, agitated, restless, anxious, sad or hopeless
depression (low mood)
problems getting to sleep, staying asleep or waking up early
tremorthe pupil (dark centre) of the eye getting larger
indigestion
constipation (not being able to poo)
feeling dizzy
a rash or itchy skin
feeling tired or lacking in energy
weight loss
chest pain

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

Young people and children are more likely to experience mood swings, changes in mood and feeling like hurting themselves or taking their own lives when taking atomoxetine. These are uncommon side effects but can be serious so it is important to be aware of them. If this happens to you, go to the hospital immediately and take your medication with you. If possible, take a friend or family member along with you to keep you safe on the way.

Additional monitoring is recommended with this medicine to check for any unwanted changes the medicine might cause and make sure your doctor can review them quickly.

Before you begin treatment, your doctor should check your blood pressure, pulse (heart rate), weight and height. They should also check this if your dose of medication is changed and at least every six months for as long as you take atomoxetine. They may do this more often if you have concerns.

They will also ask you about your mood and how you are feeling, to check that the medicine is working and if you are having any side effects.
Your doctor might also recommend additional monitoring, like checking your heart with an electrocardiogram (ECG) or checking your liver function by taking a blood test.