Considering Strattera for your ADHD treatment? Learn how Strattera works, Strattera side effects and how it fits into an overall ADHD treatment plan.

Atomoxetine, brand name, Strattera, was approved by the FDA for distribution in November 2002. It became available in US pharmacies in early 2003. Despite its hefty price tag, it is becoming widely used for adults and children with Attention Deficit Hyperactivity Disorder. (AD/HD) It is a non-stimulant medication approved for the treatment of AD/HD in both children and adults. The stimulants include methylphenidate (Ritalin, Concerta and Metadate CD) and Amphetamine (Dexedrine, Dexedrine Spansules, and Adderall XR). Stimulants are FDA approved for the treatment of AD/HD in children and adolescents, but most physicians consider them the first line medication treatment for AD/HD in adults too.

How Does Strattera Work?

Atomoxetine is a selective norepinephrine reuptake inhibitor. This means that it strengthens the chemical signal between those nerves that use norepinephrine to send messages. Atomoxetine does not appear to affect the dopamine systems as directly as do the stimulants. Atomoxetine does not seem to cause an increase in brain dopamine levels in the nucleus accumbens or the striatum areas of the brain. The stimulants appear to cause an increase in the availability of dopamine in these areas. The effect on the nucleus accumbens is believed to cause euphoria and to be responsible for the stimulants’ abuse liability. Dopamine increases in the striatum may be associated with the risk of motor tics. (1)

Although Atomoxetine’s direct effect only seems to be with norepinephrine, it appears to cause a secondary increase in dopamine levels in the prefrontal cortex area of the brain. (the brain area behind the eyes.) This part of the brain is associated with the ability to mentally rehearse responses, and inhibit impulsivity. The area is also associated with working memory.

Atomoxetine’s chemical structure bears some similarities to the tricyclic antidepressants although it is actually a phenylpropanolamine derivative. The tricyclic antidepressants include desipramine and imipramine. These two medications have been shown to be effective treatments for AD/HD in adults and children but do not have FDA approval for this use. The tricyclics affect norepinephrine but are not as specific as atomoxetine. It is the tricyclics’ effect on neurotransmitters other than dopamine and norepinephrine that appear to cause their drawbacks. Their anticholinergic effects can cause constipation, dry mouth and dry eyes. Their antihistaminergic effects can cause weight gain and tiredness. Their alpha adrenergic effects can cause tremor and changes in blood pressure. The tricyclics can cause a delay in cardiac conduction. This effect can cause minor—and in rare cases—serious changes in heart rhythm. Investigators have evaluated atomoxetine carefully for cardiac rhythm and blood pressure changes. Minor, but insignificant, increases in pulse and blood pressure were noted. Atomoxetine did not appear to cause changes in cardiac conduction. (2)

Can you abuse Strattera?

Some physicians have been reluctant to prescribe stimulants for adults because they are Schedule II and are officially listed as having a significant potential for addiction. Although stimulants can indeed be abused, their use does not seem to cause abuse individuals who do not already have a substance abuse problem. (3) However there are other ways in which stimulants can be abused. Because they decrease sleepiness and cut appetite, individuals might use them to cram for exams or lose weight. Atomoxetine appears to have minimal abuse potential. Thus, it is not as highly controlled as the stimulants. It can inhibit sleep or appetite but does so much less than the stimulants. Thus, it is less likely to be passed around.

Does Strattera have side effects?

The side effects of atomoxetine may include many of the side effects seen with stimulants. These common effects include appetite suppression, sleep disturbance jitteriness and irritability. Since there is a small increase in pulse and blood pressure, these should be monitored in patients with cardiac disease. However, these effects are often milder than those of the stimulants. Atomoxetine can cause a significant problem with nausea. In my experience, this is the most common reason for individuals stopping the drug. Taking it with meals or splitting the dose may help. Atomoxetine is most commonly given as a single dose in the morning. However there are some individuals who cannot tolerate this because they actually find the medication to be sedating. Atomoxetine can lead to urinary retention in some individuals. It can also cause problems with sexual functioning. Some individuals experience sexual side effects. such as impotence, erectile difficulties and difficulty achieving orgasm. (4) Stimulants often cause the individual to feel more alert and less sleepy. Atomoxetine can occasionally do this to a milder degree. In many individuals, individuals, however, Atomoxetine can actually cause sleepiness. I have several patients who prefer to take it at night. Atomoxetine does not usually have a rebound effect. Although the compound is metabolized quickly, the clinical effects appear to last all day and even into the following morning. This can be a good thing for individuals who find that stimulants make them feel irritable in the evenings. However, people who need to stimulant “kick” to help them focus may be disappointed in the new drug.