Must know atomoxetine side effects — from common to rare

Atomoxetine is a non-stimulant medication that can help alleviate symptoms of attention-deficit/hyperactivity disorder (ADHD). It’s effective at improving attention and can help reduce hyperactivity and impulsivity. But, atomoxetine side effects are possible. 

Learn about the common and rare side effects of atomoxetine, who should and shouldn’t take it, and how to talk to your healthcare provider about this medication. Then, start the conversation.

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What is atomoxetine?

Atomoxetine — formerly sold as brand name Strattera — is a selective norepinephrine reuptake inhibitor (SNRI). It works by increasing the amount of the chemical messengers norepinephrine and serotonin in the brain. Norepinephrine helps regulate attention, arousal, stress responses, and cognitive function. For people with ADHD, atomoxetine can help improve attention and reduce ADHD symptoms of hyperactivity and impulsivity.

The U.S. Food and Drug Administration (FDA) approved it in 2002 for the treatment of ADHD in adults and children over the age of 6. It was the first non-stimulant medication approved for ADHD treatment. Off-label uses for atomoxetine include treating hypotension, treatment-resistant depression, and ADHD in adults with major depression. 

Atomoxetine is available in capsules as a hydrochloride salt. It comes in the following dosages:

• 10 milligrams
• 18 milligrams
• 25 milligrams
• 40 milligrams
• 60 milligrams
• 80 milligrams
• 100 milligrams

For adults, the starting dose of atomoxetine is 40 milligrams. Depending on your symptoms, your provider may adjust your dosage after 3 days at any one dose. The typical target dose is 80 milligrams for adults. A single dose can be taken in the morning or a 40 milligram dose can be taken in the morning and late afternoon. If 80 milligrams isn’t enough, your provider may have you try 100 milligrams a day after 2 to 4 weeks at the 80-milligram dose. 

Atomoxetine is a good alternative for people with ADHD who don’t respond well to FDA-approved stimulant medications for ADHD, like Ritalin or Adderall, or have intolerable side effects. Because stimulant medications have the potential for abuse, misuse, and addiction, non-stimulants, like atomoxetine, may be a better treatment option for people with substance use issues. Your healthcare provider can help you decide atomoxetine/Straterra for ADHD is right for you.

If they do, and you start taking atomoxetine, here’s a rundown of side effects you might experience so you know and can talk with your healthcare provider or pharmacists about any questions you have.

Common side effects of atomoxetine

When considering atomoxetine, your provider will inform you of common side effects. For many, the side effects of antidepressants are temporary and subside as your body adjusts to the medication. 

Common atomoxetine side effects in adults include:

• Constipation
• Dry mouth
• Nausea
• Headache
• Abdominal pain
• Drowsiness
• Decreased appetite, which may lead to weight loss
• Dizziness
• Sexual side effects
• Problems passing urine
• Difficulty getting or keeping an erection
• An effect on your ability to drive or operate machinery

If you have side effects that cause discomfort or are severe, contact your provider so you can discuss dosage changes or other ADHD medication options. And if you have negative side effects while taking atomoxetine, consider reporting them to the FDA by visiting MedWatch or calling 1-800-FDA-1088.

What patients say about atomoxetine side effects

Every person reacts to medication differently. But, if you’re considering taking atomoxetine or have recently been prescribed it, it can be helpful to read about others’ experiences with it.

On Reddit, hazardzetforward shared, “I’m 4 weeks into a 40mg dose. The first few days, I had some fun digestive track side effects and random chills, but those mostly went away. The increased heart rate has stayed though. I know what you mean about it feeling uncomfortable. I keep thinking I should be anxious about something because physically my heart is much faster than usual.”

Another user, TinyUndProud said, “I started taking it two weeks ago as of today. The first two days, I experienced nausea and increased drowsiness, but after learning that eating a high protein/high fat breakfast helps, it went away, and now I take it every morning on an empty stomach without issue. The newest manifestation has been dry mouth, but I have had that before taking the meds, so it is easy to manage…it is just more frequently noticeable now.”

Sufficient-Task-8880 shared, “I take staterra, and it works for me. It has helped me to keep focused at work. I can tell when I don’t take it. The only thing I really don’t like about it is I can not take it on an empty stomach. I have to eat before I take it, or I will get super nauseous.”

Read more Strattera reviews.

Rare but serious atomoxetine side effects

Rare side effects can occur with atomoxetine. If you experience any of the following, seek medical attention, as these atomoxetine side effects can be serious:

• Suicidal thoughts and behaviors, or new or worsening anxiety, depression, aggression, or mood changes
• Severe allergic reaction, which may include symptoms like trouble breathing, rapid heartbeat, fever, nausea or vomiting, itching, skin rash, or swelling 
• Trouble starting or keeping a urine stream or difficulty emptying your bladder, which could lead to a urinary tract infection (UTI)
• Severe liver damage that can include symptoms of yellowing of the skin or eyes, dark urine, fatigue or weakness, and loss of appetite
• Heart problems including sudden death in people with heart defects or existing heart issues, heart attack, stroke, increased blood pressure and heart rate
• Slowing of growth (in children) 

Warnings and precautions for atomoxetine

In addition to understanding atomoxetine side effects, you may want to talk through the warnings and precautions for this medication with your healthcare provider to determine if it’s a good option to help you manage your ADHD symptoms. 

Here are a few warnings and precautions you should know about if you’re considering atomoxetine.

• Suicidal thoughts and behaviors: Atomoxetine has an FDA boxed warning for the risk of suicidal ideation in children and adolescents. Additionally, Some people experience suicidal thoughts when they start taking atomoxetine. Suicidal thoughts can also occur with dosage changes. If you’ve had suicidal thoughts, tell your healthcare provider before starting atomoxetine. If you decide to take atomoxetine, your provider may ask you to monitor or track your mood and reach out if you have new or worsening symptoms of depression, anxiety, panic attacks, irritability, aggression, agitation, or thoughts of suicide. 
• Serious heart problems: Whether or not you have a preexisting heart condition, atomoxetine can increase your risk of sudden death, heart attack (myocardial infarction), or stroke. Tell your provider about any cardiac conditions you have before starting atomoxetine. And seek help right away if you have shortness of breath, chest pain, or other heart issues while taking this medication.

• Severe liver problems: Because atomoxetine is metabolized by your liver, in rare cases, it can cause severe liver damage. Your provider will likely request blood work to check your liver function before you start and while you take atomoxetine. 
• Increased blood pressure and heart rate: Atomoxetine can increase these vital signs, so your healthcare provider will monitor your blood pressure and heart rate while you take atomoxetine. Your provider will ask you to reach out if you experience symptoms like headache, shortness of breath, and dizziness. Before taking atomoxetine, make sure your provider is aware of any existing medical condition you have that involves your heart or blood pressure.
• New psychotic or manic symptoms: Children and adolescents with no history of mania or psychotic symptoms (like hallucinations or delusions) can experience them with atomoxetine. If this happens, your provider will likely discontinue the medication and discuss other treatment options. 
• Exacerbation of bipolar disorder: If you have or believe you may have bipolar disorder, share your symptoms and full medical and psychiatric history, including what you know about your family, with your provider. Because of the risk of a mixed or manic episode, your provider may want to talk about alternatives. 
• Aggressive behavior or hostility: Your provider will monitor your treatment, as atomoxetine can cause new or worsening aggressive behavior or hostility. Though noted in adults during clinical trials, researchers mostly observed these behaviors in children and adolescents taking atomoxetine for ADHD. 
• Allergic reactions: Atomoxetine can cause serious allergic reactions. Seek immediate medical attention if you have symptoms like chest tightness, difficulty breathing or wheezing, rash, hives, itching, or swelling of the face, lips, tongue, or throat.
• Seizures: While Atomoxetine has a low risk of seizures, it should be used with caution in people with a history of seizures.

Drugs that can interact with atomoxetine

Atomoxetine can interact with other medications and cause serious side effects. Some of these medications include:

• Monoamine oxidase inhibitors (MAOIs) are a type of antidepressant used to treat depression and conditions like social phobia and panic disorder. Taking an MAOI with atomoxetine can lead to serious reactions like hyperthermia, fluctuations in vital signs, rigidity, agitation, and delirium. 
• Albuterol, a bronchodilator is a medication that opens your airways and is used to treat symptoms like wheezing and difficulty breathing, and conditions like asthma and chronic obstructive pulmonary disease (COPD). Your provider may not prescribe atomoxetine if you are taking albuterol because both can raise your blood pressure and heart rate. 
• CYP2D6 inhibitors. An enzyme known as CYP2D6 helps break down atomoxetine in your body. Other antidepressants, like Paxil (paroxetine) and Prozac (fluoxetine), block this enzyme, which can lead to a build-up of atomoxetine in your system. Higher levels of atomoxetine can cause tiredness and nausea. 
• Alcohol: Drinking with atomoxetine does not change the intoxicating effects of alcohol. 
• Antihypertensive drugs and pressor agents: Atomoxetine can raise your blood pressure. If you have a condition that impacts your blood pressure or take medication to help raise or lower it, your provider may not prescribe atomoxetine. 
• Methylphenidate is a stimulant medication used to treat ADHD. It’s available under the brand names Ritalin and Concerta. Methylphenidate, like atomoxetine, can raise blood pressure. Your provider may want to monitor your vitals when prescribing this combination of medications. 

To avoid serious side effects, tell your healthcare provider about any over-the-counter or prescription medications or supplements you take before starting atomoxetine.  

Who shouldn’t take atomoxetine?

Atomoxetine shouldn’t be used in some cases. If you have certain medical conditions or take specific medications, your provider won’t prescribe atomoxetine because of the potential risks. 

If you have a history of or have a pheochromocytoma (a rare type of tumor), don’t take atomoxetine. Serious reactions can occur, including high blood pressure or fast and abnormal heartbeat. People with severe cardiovascular issues, like heart disease, also shouldn’t take atomoxetine, as they may also experience similar changes in blood pressure or heart rate that can lead to serious problems. 

Atomoxetine isn’t recommended for people with narrow angle glaucoma due to an increased risk of mydriasis or dilated pupils. 

If you take or have taken an MAOI within the last 14 days, you shouldn’t take atomoxetine. Taking atomoxetine with an MAOI can lead to serious reactions like hyperthermia, rigidity, rapid fluctuations in vital signs, extreme agitation, delirium, and in severe cases, coma. 

If you have a known hypersensitive to atomoxetine, let your provider know. 

Who should take atomoxetine with caution?

If you have certain health conditions, you may be able to take atomoxetine, but your healthcare provider will want to monitor how you do on the medication. 

Atomoxetine is metabolized by your liver. Your kidneys help your body eliminate it. Liver or kidney issues can affect how your body processes atomoxetine, which can lead to a build-up of atomoxetine in your blood and result in side effects. If you have liver or kidney problems, you may take atomoxetine, but your provider will want to monitor medication levels in your bloodstream and your kidney function. 

Atomoxetine has an FDA boxed warning. A boxed warning is a serious type of warning the FDA issues when a medication has the risk of life-threatening side effects or safety concerns. Atomoxetine can increase the risk of suicidal thoughts or behaviors in children and adolescents. People with suicidal thoughts and behaviors may take atomoxetine, but their provider will likely monitor how they are doing on the medication and make changes if needed. 

What to tell your healthcare provider before using atomoxetine

Before prescribing atomoxetine, your healthcare provider will need to know details of your medical and mental health history to help determine if it’s a medically appropriate option for you. 

Here are some topics it’s important to discuss with your provider before using atomoxetine:

• Your symptoms and their severity
• How your symptoms affect your daily life
• If you have thoughts of harming yourself or others
• Any mental health conditions you’ve been diagnosed with and how you’ve treated them
• Any medical issues you have, like high blood pressure, glaucoma, liver or heart disease, or seizures
• Over-the-counter or prescription medications you’re taking 
• If you use drugs or drink alcohol
• Any allergies you may have to medications or other substances
• If you’re pregnant, planning to become pregnant, or breastfeeding

What to do if you miss a dose of atomoxetine

If you start on atomoxetine and miss a dose, take it as soon as you remember. But, if it is almost time for your next dose, skip your missed dose. Take your next dose at the normal time and continue with your regular medication schedule. Don’t take more than your daily prescribed amount of atomoxetine in a 24-hour period. 

What to do if you overdose on atomoxetine

If you overdose on atomoxetine, you may need medical attention. For guidance, call your doctor or the Poison Control Center at 1-800-222-1222. 

Symptoms of atomoxetine overdose include:

• Gastrointestinal symptoms
• Somnolence
• Dizziness
• Tremor
• Hyperactivity
• Increased heart rate
• Increased blood pressure
• Dry mouth
• Agitation
• Disorientation
• Hallucinations
• Abnormal behavior

In some cases, atomoxetine overdose can cause seizures. If you experience a seizure or other medical emergency, call 911 for immediate help. 

How to store atomoxetine

Keep atomoxetine in its original container. To prevent any damage to your medication, keep it away from moisture and excessive heat. The FDA recommends storing it at room temperature or around 77 degrees Fahrenheit.

Most importantly, store your atomoxetine out of reach of children and pets. Accidentally taking atomoxetine can lead to vomiting, increased heart rate, and cognitive issues. 

What else to know about atomoxetine

Though atomoxetine can interact with other medications, it isn’t known to have any food interactions. Your provider may recommend that you avoid or limit alcohol while you take atomoxetine. Mixing atomoxetine and alcohol can increase the risk of side effects like dizziness, nausea, drowsiness, and impaired coordination. 

Your provider may recommend that you take your atomoxetine at the same time each day (usually in the morning). You can take the medication with or without food, but it’s important to take the capsule whole. Don’t break, chew, or crush it. 

Taking your medication consistently and as prescribed may help you get the most benefit for your ADHD. Medication alone can help manage symptoms, but it’s often most effective when combined with ADHD therapy. 

Key takeaway

• Atomoxetine is an effective non-stimulant medication for ADHD. It helps improve attention and reduce hyperactivity and impulsivity. 
• Common and rare but serious side effects can occur with atomoxetine. Reach out to your provider about common side effects of atomoxetine that bother you. If you experience a rare or serious side effect, seek medical attention immediately. 
• Before starting atomoxetine, share your full medical and mental health history along with any over-the-counter or prescription medications you take with your provider to avoid common or serious side effects. 
• To get the most benefit from atomoxetine, take it as prescribed. Follow your provider’s instructions for your daily dose and what to do if you miss one. 

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Learn about how the right ADHD medication can help you manage your symptoms. Talk with a qualified professional about whether atomoxetine is a good option for you in as little as 24 hours.* Find a provider on Klarity Health today!