Selective Noradrenaline Reuptake Inhibitor (SNRI) — Non-stimulant ADHD Treatment Pregnancy: Should not be used during pregnancy unless the potential benefit justifies the potential risk to the foetus — clinical data on exposed pregnancies are limited and insufficient to indicate either an association or a lack of association with adverse pregnancy and/or lactation outcomes; animal studies in general do not indicate direct harmful effects. Breast-feeding: atomoxetine and/or its metabolites were excreted in the milk of rats; it is not known if atomoxetine is excreted in human milk, and because of the lack of data atomoxetine should be avoided during breastfeeding.

Atomoxetine

Brand names: Strattera

Atomoxetine is a non-stimulant medicine used to treat attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Initiate at a total daily dose of 40 mg; maintain the initial dose for a minimum of 7 days before upward titration according to clinical response and tolerability. Recommended maintenance daily dose 80 mg to 100 mg

Route: Oral

Frequency: Once daily in the morning; patients who do not achieve a satisfactory clinical response (tolerability, e.g. nausea or somnolence, or efficacy) on a single daily dose may benefit from twice daily evenly divided doses in the morning and late afternoon or early evening

Max: Maximum recommended total daily dose 100 mg. The safety of single doses over 120 mg and total daily doses above 150 mg has not been systematically evaluated

Source: UK SPC (eMC) for ATOMAID 10 mg Capsules, Hard, §4.2 (https://www.medicines.org.uk/emc/product/12645/smpc). PAEDIATRIC OVER 70 kg BODY WEIGHT (fixed dose, not per-kg): initiate at a total daily dose of 40 mg, maintain for a minimum of 7 days before upward titration; recommended maintenance dose 80 mg; no additional benefit demonstrated above 80 mg; maximum recommended total daily dose 100 mg; safety of single doses over 120 mg and total daily doses above 150 mg not systematically evaluated. The per-kg regimen for paediatric patients up to 70 kg is given in paedDose below. Verify any under-18 use against a children's formulary. PRE-TREATMENT SCREENING: take an appropriate medical history and conduct a baseline evaluation of cardiovascular status including blood pressure and heart rate. ONGOING MONITORING: blood pressure and pulse recorded after each dose adjustment and then at least every 6 months; a centile chart is recommended for paediatric patients; for adults, follow current reference guidelines for hypertension. WITHDRAWAL: no distinct withdrawal symptoms described; in cases of significant adverse effects atomoxetine may be stopped abruptly, otherwise the drug may be tapered off over a suitable period. Re-evaluate the need for continued therapy beyond 1 year, particularly once a stable and satisfactory response is reached. HEPATIC IMPAIRMENT: moderate (Child-Pugh B) — reduce initial and target doses to 50% of the usual dose; severe (Child-Pugh C) — reduce initial and target doses to 25% of the usual dose. CYP2D6 POOR METABOLISERS (approximately 7% of Caucasians): several-fold higher exposure and higher risk of adverse events; for patients with a known poor metaboliser genotype a lower starting dose and slower up-titration may be considered. ELDERLY: use in patients over 65 years of age has not been systematically evaluated. CHILDREN UNDER 6 YEARS: safety and efficacy not established — should not be used. METHOD OF ADMINISTRATION: oral, with or without food. §4.4 and §4.8 were truncated at the source-fetch limit in this bundle; §4.5 was not retrieved at all — verify the complete interactions section (interactions listed below are drawn from §4.2/§4.3 of the UK SPC and the US label's drug-interaction summary, as marked).

Paediatric dose

Dose: 1.2 mg/kg/day/kg

Route: Oral

Frequency: Total daily dose, given once daily in the morning or as two evenly divided doses in the morning and late afternoon/early evening

Max: The SPC states no additional benefit has been demonstrated for doses higher than 1.2 mg/kg/day, and that the safety of single doses over 1.8 mg/kg/day and total daily doses above 1.8 mg/kg has not been systematically evaluated. No numeric maximum beyond this is stated for patients up to 70 kg

Applies to paediatric patients UP TO 70 kg body weight. Initiate at a total daily dose of approximately 0.5 mg/kg; maintain the initial dose for a minimum of 7 days prior to upward dose titration according to clinical response and tolerability; the recommended maintenance dose is approximately 1.2 mg/kg/day (depending on the patient's weight and available dosage strengths). Paediatric patients OVER 70 kg use the fixed adult-style regimen (see adultDose.notes). Should not be used in children under 6 years of age (safety and efficacy not established). In some cases it might be appropriate to continue treatment into adulthood. Verify against a children's formulary before prescribing. Source: UK SPC (eMC), ATOMAID 10 mg Capsules Hard, §4.2.

Dose adjustments

Renal

Atomoxetine can be administered to ADHD patients with end stage renal disease or lesser degrees of renal insufficiency using the usual dosing regimen. Subjects with end stage renal disease had about a 65% higher systemic exposure than healthy subjects, but there was no difference when exposure was corrected for mg/kg dose. Atomoxetine may exacerbate hypertension in patients with end stage renal disease.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Combination with monoamine oxidase inhibitors (MAOI) — and within a minimum of 2 weeks of stopping an MAOI; an MAOI should not be started within 2 weeks of stopping atomoxetine
Narrow angle glaucoma
Severe cardiovascular disorders (may include severe hypertension, heart failure, arterial occlusive disease, angina, haemodynamically significant congenital heart disease, cardiomyopathies, myocardial infarction, potentially life-threatening arrhythmias and channelopathies)
Severe cerebrovascular disorders (may include cerebral aneurysm or stroke)
Phaeochromocytoma or a history of phaeochromocytoma

Side effects

Headache (about 19%), abdominal pain (about 18%) and decreased appetite (about 16%) in paediatric placebo-controlled trials — abdominal pain and decreased appetite are usually transient
Nausea, vomiting and somnolence in about 10–11% of patients, particularly during the first month of therapy
Increases in heart rate and systolic and diastolic blood pressure; orthostatic hypotension (0.2%) and syncope (0.8%)
Psychiatric (common): irritability, mood swings, insomnia, agitation, anxiety, depression and depressed mood, tics; (uncommon) suicide-related events, aggression, hostility, emotional lability
Growth retardation early in therapy in terms of both weight and height gain, associated with decreased appetite (on average patients recovered to mean predicted weight and height over long-term treatment)
Other: dizziness, mydriasis, palpitations, sinus tachycardia, constipation, dyspepsia; uncommon — tremor, migraine, paraesthesia; rare — psychosis including hallucinations, seizure, QT interval prolongation

Interactions

Monoamine oxidase inhibitors — contraindicated; serious, sometimes fatal reactions reported with drugs affecting brain monoamine concentrations (US label §7.1)
Strong CYP2D6 inhibitors, e.g. paroxetine, fluoxetine, quinidine — increase atomoxetine steady-state plasma concentrations in extensive metabolisers to exposures similar to poor metabolisers; the US label advises initiating at 0.5 mg/kg/day (or 40 mg/day for >70 kg and adults) and increasing to the usual target only if symptoms fail to improve after 4 weeks and the initial dose is well tolerated (US label §2.4, §7.2)
Antihypertensive drugs and pressor agents — possible effects on blood pressure (US label §7.3)
Salbutamol/albuterol or other beta-2 agonists — action on the cardiovascular system can be potentiated (US label §7.4)

Clinical monograph

How it works

It is a selective noradrenaline (norepinephrine) reuptake inhibitor, increasing noradrenergic neurotransmission in regions relevant to attention and impulse control.

Prescribing in practice

Patients and carers must be warned to watch for and report suicidal thinking or behaviour, particularly early in treatment, and rare severe hepatic injury can occur.
Blood pressure and heart rate can rise, so assess cardiovascular status before and during treatment.
Use a children's formulary for paediatric dosing and reduce the dose in hepatic impairment.

Monitoring

Monitor blood pressure, heart rate, growth in children, mood and signs of liver injury during treatment.

Counselling the patient

Full benefit may take several weeks to develop.
Seek urgent advice if there are new or worsening thoughts of self-harm, or signs of liver problems such as jaundice or dark urine.
Report palpitations, fainting or unexplained chest pain.

Evidence & guidelines

NICE recommends atomoxetine as an option for ADHD, supported by randomised controlled trial evidence.

Reference: NICE NG87 (ADHD); Strattera SPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways