atomoxetin

Atomoxetin, also spelled atomoxetine, is a selective norepinephrine reuptake inhibitor (NRI) used to treat attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. It provides a non-stimulant alternative to stimulant medications such as methylphenidate or amphetamine formulations. Atomoxetin is sold under the brand name Strattera and is available as a generic drug.

Mechanism and pharmacology: Atomoxetin increases noradrenergic signaling by blocking the norepinephrine transporter, with activity centered in brain regions involved in attention and impulse control. It is not a controlled substance. The drug is primarily metabolized in the liver by the CYP2D6 enzyme to 4-hydroxyatomoxetine, an active metabolite. Genetic variation in CYP2D6 affects drug exposure, with poor metabolizers experiencing higher and more prolonged levels. Pharmacokinetics can vary widely between individuals.

Clinical use: Atomoxetin is approved for ADHD in both pediatric and adult populations and is often chosen when stimulants are ineffective, not tolerated, or when comorbid conditions (such as anxiety or tic disorders) make stimulant therapy less suitable. Symptom improvement typically becomes evident after several weeks of therapy. Dosing is tailored to age and response, commonly starting at low doses and titrating upward to a target range (for adults often up to 100 mg per day; for children and adolescents, dose is weight-based and capped per guidelines).

Safety and adverse effects: Common adverse effects include stomach upset, decreased appetite, nausea, dizziness, insomnia or sleepiness, and sexual dysfunction. Blood pressure and heart rate can increase modestly. Rare but serious risks include liver injury and, in youth, potential increases in suicidal thoughts or actions. Atomoxetin should be avoided with monoamine oxidase inhibitors and used with caution in patients with significant cardiovascular disease, severe liver impairment, or glaucoma.

History and regulation: Developed by pharmaceutical companies and approved by regulatory authorities as a non-stimulant ADHD medication. It is widely used worldwide and remains available both as a brand-name product and as a generic.