Strattera is the brand name of atomoxetine, the first non-stimulant medicine approved for treating attention-deficit hyperactivity disorder. It isn’t classified as a controlled substance and doesn’t carry the misuse risk that stimulants carry, and it works throughout the day without waves of highs and lows. On the other hand, its effect doesn’t appear quickly like stimulants; it needs weeks, and it has particular warnings about mood in young people and about the liver and heart. Here we explain who it suits and who it doesn’t, and what the patient or family should expect, without doses. The availability of the brand name in Egypt changes, so ask the pharmacist what atomoxetine is available.
What is Strattera (atomoxetine)?
Atomoxetine blocks the reuptake of noradrenaline, a neurotransmitter that plays a role in attention, planning and impulse control, so it stays longer in the spaces between nerve cells, especially in the brain’s frontal cortex. This differs from stimulants such as methylphenidate (Ritalin), which raise dopamine and noradrenaline together. It comes in capsules, and the capsule shouldn’t be opened or its contents chewed, because the medicine irritates the eyes and skin. The general picture of treatment and options by age is in our article on ADHD treatment.
Who is atomoxetine prescribed for?
- Children aged six and over, teenagers and adults: with attention-deficit hyperactivity disorder, as one of the approved treatment options.
- Those for whom stimulants don’t suit: because of a weak response or troublesome side effects such as severe insomnia, loss of appetite or palpitations.
- Those with accompanying anxiety or tics: because stimulants may increase anxiety or tics in some, so the doctor prefers a non-stimulant option.
- Those with a history of substance use or a misuse risk in the family: because atomoxetine doesn’t carry the known misuse risk of stimulants, a subject we discuss in our article on ADHD and addiction.
- Those who need extended cover throughout the day: such as those who struggle in the evening and early morning when a stimulant’s effect has worn off.
When does its effect appear?
This is the point that frustrates families most. A mother gives her son Strattera after trying stimulants, and on the third day says it “isn’t working”. In reality the first effect may appear within one to four weeks, and the full effect may need six weeks or more. That is why the doctor gives it enough time before judging it. During this period the family helps by recording teachers’ comments and what the parents notice each week, instead of relying on daily impressions. Stopping the medicine for two or three days and then going back to it doesn’t make it “work immediately”; it isn’t an as-needed medicine.
A quick comparison with stimulants
| Comparison | Atomoxetine | Stimulants (such as Ritalin) |
|---|---|---|
| Speed of effect | Weeks | Within hours of first use |
| Cover | Continuous throughout the day | Ends when the dose wears off |
| Misuse risk | Low, and not classified as a controlled substance | Present and needs caution |
| Insomnia and loss of appetite | Usually less, sometimes with nausea and drowsiness | Common |
| Response | Usually less powerful for many | Usually stronger for most patients |
This doesn’t mean one is absolutely better; the choice is case by case. If the problem is students using stimulants without a prescription, read Adderall and modafinil.
Common side effects
- Reduced appetite, nausea and stomach pain, especially in the first weeks.
- Dry mouth and constipation.
- Drowsiness or insomnia, which varies between people.
- Dizziness and headache.
- Irritability, mood swings and quick temper.
- A slight rise in pulse and blood pressure.
- In adults: sexual problems, and difficulty urinating in some men.
Many of these effects ease after the first weeks, and taking it after food or in the evening may help, as the doctor advises. The doctor follows height and weight in children, and measures blood pressure and pulse at intervals.
The warning about mood and harmful thoughts
Atomoxetine carries an official warning of a slight increase in suicidal thoughts in children and teenagers in reference studies, which is why the child is closely monitored in the first weeks and at any change in the plan. The family is asked to notice any sudden change: deep sadness, isolation, new aggression, talk of death or of not wanting to live, or unusual impulsivity.
If anything like this appears, contact the doctor the same day, and in immediate danger call an ambulance on 123 or the mental health line on 16328. These signs aren’t inevitable, and most patients experience none of them, but monitoring is part of safe use.
The liver and the heart
In very rare cases the medicine may harm the liver. The signs: dark urine, yellowing of the skin or eyes, pain in the upper abdomen, itching, severe nausea and unexplained tiredness. If they appear, contact the doctor immediately; they decide whether to stop the medicine. As for the heart, the medicine may raise the pulse and blood pressure slightly, so it isn’t given to someone with a serious structural heart disease or uncontrolled high blood pressure without a cardiologist’s approval. Tell the doctor if there is a family history of sudden cardiac death at a young age.
Drug interactions
- CYP2D6 enzyme inhibitors: such as the antidepressants paroxetine and fluoxetine, and bupropion, slow its breakdown so its level rises, and the doctor adjusts the plan.
- Monoamine oxidase inhibitors: combining with them, or within two weeks of stopping them, is forbidden.
- Medicines that raise blood pressure or pulse: such as some asthma and cold medicines; the effects add up.
- Blood pressure-lowering medicines: the medicine may weaken their effect.
Its breakdown differs from person to person according to their genes: some people are “slow metabolizers” in whom the level rises, which explains why some tolerate it easily and others don’t.
Painful erection and other rare symptoms
Rarely, a painful erection lasting more than four hours may occur; this is an emergency that needs the emergency department immediately. A rash, swelling or allergy symptoms may also appear, in which case the doctor should be consulted.
The role of family and school alongside the medicine
The medicine is part of the plan, not all of it. A child taking atomoxetine benefits more when the daily routine is clear, homework is divided into small tasks, and the teacher knows how to help them sit away from distractions. Teenagers and adults benefit from organizing with calendars and reminders and breaking projects down. If the family notices improvement in calm without improvement in schoolwork, this is worth discussing with the doctor, as skills or educational support may be added instead of changing the medicine. Teachers’ precise feedback gives a better measure than a general impression.
Stopping the medicine, and pregnancy
Atomoxetine doesn’t usually need very slow tapering like stimulants or antidepressants, but it is only stopped or changed by the doctor’s decision. Data in pregnancy and breastfeeding are limited, so a mother discusses it with the doctor after weighing benefits and risks.
Seek urgent help immediately if you see
While using atomoxetine or after an excess amount of it, call an ambulance on 123 or the mental health line on 16328:
- Thoughts of self-harm or ending life, or talk about it
- Yellowing of the eyes or skin with dark urine and abdominal pain
- A painful erection lasting more than four hours
- Chest pain, fainting or strong palpitations
- Severe agitation, new aggression or hallucinations
- Seizures or deep sleepiness
How can Riviera Life help you?
If you are looking for an ADHD treatment without the risk of stimulants, have started stimulants and are suffering their effects, or are using stimulants to be able to concentrate, an assessment with a consultant psychiatrist is the starting point. We provide this in complete confidentiality, with a family program and aftercare. The first consultation is free on +201507999722.
More from our ADHD guide
Questions many people ask
No. It is a non-stimulant treatment that acts on noradrenaline, isn't classified as a controlled substance, and doesn't carry the known misuse risk of stimulants.
Usually weeks: the first effect may appear after one to four weeks, and the full effect may take six weeks or more.
It carries an official warning of a slight increase in such thoughts in young people, so close monitoring and contacting the doctor about any change are needed.
Dark urine, yellowing of the skin or eyes, pain in the upper abdomen and itching. Very rare, but they call for seeing the doctor immediately.
Usually slower and less powerful for many patients, but more suitable for some. The choice is individual and decided by the doctor according to the case.
