Centrally acting sympathomimetics
ATC code: N06BA09 (Atomoxetine)
Brand names
Atomoxetina Cinfa, Strattera, Atomoxetina Tecnimede, Atamax
Selective norepinephrine reuptake inhibitor (NRI). Unlike methylphenidate and amphetamines, it does not affect striatal dopamine transporters and does not induce euphoria – not a controlled substance, low abuse potential. Raises norepinephrine and dopamine in the prefrontal cortex, improving attention, impulse control, and working memory. Metabolized by CYP2D6 – in poor metabolizers (7-10% of Europeans, 1-2% of Asians) levels are 5-10-fold higher.
Second line
Second-line ADHD therapy in children over 6, adolescents, and adults after stimulant failure or intolerance (methylphenidate, lisdexamfetamine) per 2018, 2019, and Spanish SEPP 2022. Starting dose 0.5 mg/kg once daily, increased to 1.2 mg/kg (max 100 mg/day) after 7-14 days. Full effect at 4-6 weeks. Particularly effective in patients with comorbid anxiety or tics (stimulants exacerbate them).
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Atomoxetine is a selective norepinephrine reuptake inhibitor. It is prescribed only for attention-deficit/hyperactivity disorder (ADHD) in children over 6 and adults ( 2019 and AAFP 2020 guidelines). Healthy students and knowledge workers take atomoxetine as a cognitive stimulant outside an ADHD indication. No clinical studies in healthy adults exist; an effect on cognition in people without ADHD has not been confirmed. The drug has specific risks: boxed warning for suicidal thoughts in children and adolescents, hepatotoxicity with risk of acute liver injury, and elevated blood pressure and heart rate. If atomoxetine is being taken for concentration outside an ADHD indication, consider seeking a second opinion.
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Boxed warning
FDA boxed warning 2005: increased suicidal ideation in children and adolescents. Mood and behavior monitoring in the first weeks of therapy, parental education.
Limited human pregnancy data. Used only when clearly necessary. For planned pregnancy, discuss alternatives – behavioral therapy.
Limited milk excretion data. If therapy is required, discuss switching to non-pharmacological management.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Atomoxetine is evaluated for the following indications with varying evidence strength: ADHD (evidence tier A), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Atomoxetine (≥ 1 in 100): Decreased appetite, Nausea, Abdominal pain, Dry mouth, Fatigue, Decreased libido in adults. See the Safety section for uncommon and serious reactions.
FDA category C. Limited human pregnancy data. Used only when clearly necessary. For planned pregnancy, discuss alternatives – behavioral therapy.
Limited milk excretion data. If therapy is required, discuss switching to non-pharmacological management.
Atomoxetine is contraindicated in: Hypersensitivity; Closed-angle glaucoma; Pheochromocytoma; MAO inhibitor combination; Severe cardiovascular disease (CAD, severe HF, severe arrhythmias). Full list in the Safety section.
FDA boxed warning 2005: increased suicidal ideation in children and adolescents. Mood and behavior monitoring in the first weeks of therapy, parental education.