Atomoxetine Review: The Best ADHD Medication?

Atomoxetine Review: The Best ADHD Medication?


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Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.

Atomoxetine, sometimes referred to by its full chemical name atomoxetine hydrochloride or atomoxetine HCL for short, is a prescription drug that's FDA-approved to treat attention deficit hyperactivity disorder (ADHD).

But is atomoxetine actually proven in clinical trials to reduce ADHD symptoms? Does the drug cause any side effects? How does it compare to Adderall and its branded alternative Strattera? And how do real users describe its effects?

In this article we’ll answer all of these questions and more as we review clinical studies on atomoxetine to determine whether or not it's effective, document its side effects, compare it to other ADHD medications and share real, unsponsored user reviews of the drug.

Can Atomoxetine Resolve ADHD?

There have been many clinical trials examining the effectiveness of atomoxetine for treating symptoms of ADHD, on both pediatric (children) and adult patient populations.

A meta-study published in the Pediatric Drugs journal examined how effective atomoxetine is for children with ADHD, and compared it to other drugs. 

The study authors concluded that atomoxetine is more effective than all other ADHD medications in both children and adolescents. Those taking atomoxetine had higher scores for health-related quality of life than the patients who were taking placebo (inert) pills.

Atomoxetine has also been extensively studied in trials for adults with ADHD. A 2004 medical trial documented that atomoxetine caused ADHD symptom reductions greater than 28% after 10 weeks of treatment.

Another thorough medical review analyzed patient data from over 3,000 patients with ADHD who took atomoxetine.

The researchers found that atomoxetine was effective on average for treating ADHD. However, the study authors did note that the medication “has a poor benefit-risk balance for the treatment of adults with ADHD,” because the benefits were mild and the side effects were worse than with placebo treatment.

We will conclude from the available medical literature that atomoxetine is effective for treating ADHD in children, adolescents and adults.

Atomoxetine Side Effects

Atomoxetine has a side effect profile that is concerning in our opinion. The drug is required to list a “black box” warning on its FDA label. This is the most severe level of warning issued by the FDA, and indicates a side effect which may be life-threatening.

Atomoxetine's black box warning references that the drug can increase suicidal thoughts in children and adolescents

A medical review examined the more common side effects of atomoxetine and reported those to be headache, abdominal pain and nausea. These are clearly mild when compared with the suicide risk.

Some cardiovascular side effects were also reported in the linked medical review as “common side effects” of the drug: increased heart rate, sinus tachycardia (irregular and fast heartbeat), increased blood pressure, heart palpitations.

Approximately 4% of children and adolescents using atomoxetine had an increase in heart rate of greater than 25 beats, which is a significant increase.

Given that atomoxetine may cause such severe side effects in children and adolescents, it may be beneficial for parents to speak with their pediatrician about alternative ADHD medications that do not have an association with suicidal thoughts.

Atomoxetine Vs. Adderall

Adderall is a commonly-prescribed ADHD medication, so patients are often curious about which drug is more effective.

Adderall is an amphetamine, and is in a class of drugs called stimulants, which increase activity of the central nervous system and brain. This drug has a different mechanism of action than atomoxetine.

Several medical trials have directly compared the efficacy of Adderall and atomoxetine.

One clinical trial published in 2006 found that the drugs had similar efficacy, but that the extended release (XR) formulation of Adderall led to greater improvements in ADHD symptoms than atomoxetine. It’s unsurprising that an XR version of a drug would be more effective, because this drug type tends to have a higher dosage than the standard release version, but this means the drug may have a greater risk of side effects as well.

A separate medical review, published in the Clinical Therapeutics journal, found that in children and adolescents who responded poorly to Adderall, switching to atomoxetine improved mental health outcomes and reduced symptoms of ADHD.

Another comparative study on Adderall XR and atomoxetine for children with ADHD found that Adderall XR was more effective.

Based on the available research, it appears that Adderall XR (but not regular Adderall) may be slightly more effective than atomoxetine in both children and adults. However, it may also confer a greater risk of side effects given that XR versions of drugs are often more potent.

Real, Unsponsored Atomoxetine User Review

One of the most popular YouTube reviews of atomoxetine is published by a creator called "Finding Your Serenity." She shares her experience after using atomoxetine at a 25 mg dose for one year, including its effects on focus and side effects from the drug:

Atomoxetine Dosage

Atomoxetine is prescribed at a wide variety of doses, which is typical for medications  prescribed to both children and adults. Children are prescribed lower doses of medication due to their lower average body weight. 

According to StatPearls, which is one of the largest medical databases in the U.S., atomoxetine capsules come in the following doses: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg.

The typical starting dose for children is reported as ranging between 0.5 mg per kilogram (kg) and 1.4 mg per kg. This equals a dose of around 40 mg for a child weighing 88 pounds (which equates to 40 kg). The typical starting dose for adults is reported as 40 mg daily.

Doctors typically prescribe medications at the lowest effective dose, and slowly titrate the dose up, to minimize risk of side effects. Especially for a drug like atomoxetine which has an FDA black box warning, it seems logical to start at the lowest therapeutic dose and only increase dose if a patient isn’t experiencing benefit.

Is Branded Atomoxetine Better?

As we documented in our Strattera review article, there is no medical evidence that brand-name versions of drugs are more effective than generic versions, so we would recommend that patients speak with their doctor about generic atomoxetine rather than brand-name Strattera. These two drugs have the same active drug ingredient.

A meta-study published in the PLOS Medicine journal analyzed data from over 1 million patients and found that, on average, generic drugs were equally safe and effective to their brand-name counterparts.

At the time of updating this article, the retail price for Strattera is $534.64 according to SingleCare, while atomoxetine can be purchased at the same dose for $9 on Cost Plus Drugs (Mark Cuban's venture).

Can an OTC Supplement Treat ADHD?

Patients are often curious about whether there are research-backed over-the-counter (OTC) treatments for ADHD.

Ginkgo biloba extract is an herbal supplement with proven nootropic function. This means it can increase cognition and concentration short-term.

clinical trial published in 2014 found that ginkgo biloba extract was effective for children diagnosed with ADHD. Supplementation with ginkgo biloba extract improved ADHD core symptoms and quality of life. 

A separate clinical trial published in the Complementary Therapies in Clinical Practice journal found that ginkgo biloba extract may be an effective adjunctive therapy to standard pharmaceutical ADHD treatment. An adjunctive therapy means a therapy used in combination with standard treatment.

Inattention scores (a common symptom of ADHD) were significantly decreased with ginkgo biloba extract complementary therapy. Total ADHD symptom score was also significantly decreased.

Illuminate Labs sells a ginkgo biloba extract supplement which is third-party tested to ensure label accuracy, potency and purity, and which contains no questionable additive ingredients.

We are not suggesting that ginkgo biloba extract is effective as a standalone ADHD treatment, or that it’s as effective as atomoxetine. We’re simply sharing some promising early research on the compound. Patients may benefit from speaking with their doctor about the potential for ginkgo biloba extract to be a supportive ADHD treatment.

Atomoxetine User Reviews

Atomoxetine has been reviewed over 500 times on Drugs.com for treating ADHD. The drug only has an average rating of 5.1/10, which is one of the worst average ratings we’ve seen.

The top positive review of atomoxetine is written by a user named “Estefano PPT” who gave the drug a 10/10 rating and claims that it improved their focus:

"it worked like magic on the first day. No side effects. I feel more alert, more energized, and can continue to focus even during boring tasks."

The top negative review is published by a user named "Philip V." who gives the drug a 1/10 rating, and claims it caused significant side effects:

"On 40mg I finally got to know, what real anxiety is. Staying up ‘till 3 am, sitting on my bed with racing thoughts, fast heart beat and high blood pressure...Waking up a few times per night, sometimes with hypnagogic hallucinations and feeling like a total trash throughout the next day"

How Does Atomoxetine Work?

Atomoxetine is a member of a drug class called norepinephrine reuptake inhibitors (NRI). The mechanism of action of this class of drugs is to delay the body’s natural processing and clearance of a neurotransmitter called norepinephrine, which leads to artificially elevated circulating levels of this compound in the brain.

Norepinephrine is shown in medical studies to improve central nervous system (CNS) performance, optimize brain plasticity and also improve memory. By artificially increasing levels of norepinephrine in the brain, atomoxetine can theoretically enhance aspects of brain function that are especially beneficial to ADHD patients.

Stay up-to-date on our research reviews

Conclusion

Atomoxetine is effective for treating ADHD, but has a risk of significant side effects such as suicidal thoughts and increased heart rate in children and adolescents. The drug's safety profile appears more favorable for adults.

Adderall XR may be slightly more effective than atomoxetine for ADHD, but has its own risk of side effects given that it’s a potent stimulant drug. We have not come across any evidence suggesting that atomoxetine is more or less effective than regular Adderall.

We would recommend that patients considering this medication speak with their doctor about atomoxetine over its branded alternative Strattera which should be similarly effective but is far more expensive at retail price.

The user reviews of atomoxetine for treating ADHD have a worse average score than most of the prescription medications we've reviewed on Illuminate Health.




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