Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Atomoxetine is a prescription drug used to treat Attention Deficit Hyperactivity Disorder (ADHD), and is approved by the Food and Drug Administration (FDA) in the U.S. to do so. The drug is used by patients to improve attention, concentration and focus, all of which can suffer as a result of ADHD.
The brand name version of the drug is Strattera, and as we outlined in our Strattera reviews article, these two terms refer to the exact same active drug ingredient. Thus we will use them interchangeably throughout this article.
In this article we’ll review published medical studies on atomoxetine to determine if the drug is safe and effective for treating ADHD. We’ll highlight side effects of the medication, explain whether the generic or branded version is more effective, and compare the drug’s efficacy to Adderall.
Does Atomoxetine Work?
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 found that the drug reduced average scores on the Clinician Global Impression of Severity Scale, which is used as a standard to measure the severity of ADHD symptoms. This scale measures the difficulty of completing daily tasks such as getting out of bed or sitting through dinner on a scale of zero to three.
The symptom reductions were over 10% greater for ADHD patients taking atomoxetine than those taking placebo.
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. This doesn’t mean it was effective for every patient; just that it was significantly superior to placebo. ADHD symptoms were reduced as reported by both patients and clinicians. 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 can conclude from the available medical literature that atomoxetine is effective for treating ADHD in children, adolescents and adults.
How Does Atomoxetine Work?
Atomoxetine is a member of a drug class called norepinephrine reuptake inhibitors (NRI). These drugs 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.
Many of our recent medication reviews covered drugs like bupropion which are part of a more common class of drugs called selective serotonin reuptake inhibitors (SSRI) which have a similar mechanism of action. These drugs delay the body’s processing of a different neurotransmitter called serotonin, which causes elevated levels 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 its levels, atomoxetine can theoretically enhance some aspects of brain function that are especially beneficial to ADHD patients.
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.
In the case of atomoxetine, the warning relates to the drug’s risk of increasing suicidal thoughts and actions in children and adolescents. The black box warning does not reference an increased risk of suicidality for adults. This risk is rare but definitely worth speaking with a doctor about for patients considering atomoxetine, especially for those with a personal or family history of suicidal thoughts or attempts.
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, especially considering that ADHD itself typically isn’t a life-threatening condition.
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 various ADHD clinical scoring systems. It’s unsurprising that an XR version of a drug would be more effective, because these forms of the drug are typically higher-dosed, but this means the drug may carry a higher 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.
One final medical trial compared Adderall XR and atomoxetine for children with ADHD, and found that Adderall XR was more effective.
Based on the available research, it seems as though Adderall may be slightly more effective than atomoxetine. However we strongly recommend against patients making any changes to their prescription medication use without speaking with a doctor first.
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 milligrams (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/kilogram (kg) and 1.4 mg/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 possible dose and only increase dose if a patient isn’t experiencing benefit.
Should I Take the Branded Version of Atomoxetine?
As explained in the introduction of this article, the brand name version of atomoxetine is Strattera. Both atomoxetine and Strattera contain the same active chemical compound, so patients are often curious about which medication to take.
Because both branded and generic versions of drugs contain the same active drug ingredient, we typically recommend that patients speak with their doctor about the generic version; in this case atomoxetine. It seems logical to take a generic version of a drug which is often significantly cheaper.
An extensive medical review compared the effectiveness of branded and generic drugs using data from thousands of patients. The researchers found that generic drugs were just as effective as brand name drugs on average. This is what would be logically expected, but it’s useful to see it reflected in medical studies.
OTC Nootropic Compounds
Given that atomoxetine carries the risk of severe side effects, it may be worthwhile for patients with milder forms of ADHD to speak with their doctor about over-the-counter (OTC) supplements which are proven effective at enhancing cognition.
A nootropic compound is a medical term for a compound which is proven in clinical trials to improve human cognition either short-term or long-term.
We’re not suggesting that these compounds are as effective as atomoxetine; just that they may be a worthwhile option for patients with mild cases of ADHD when considering both efficacy and safety.
Ginkgo biloba is probably the most well-studied herbal nootropic compound. A medical review on the herb found that it significantly improved cognitive function in patients with mild cognitive impairment.
Another medical study published in the Journal of Alzheimer’s Disease journal found that ginkgo biloba extract supplementation was especially effective when administered to patients with neuropsychiatric symptoms, which is a promising result for patients with ADHD.
Most of the ginkgo biloba supplements used in medical studies appear to be standardized to 24% flavone glycosides and 8% terpene lactones. These are the active chemical compounds in ginkgo biloba, and are theorized to be responsible for most of the herb’s effect on human cognition. Given these research standards, it seems logical for those considering ginkgo to pursue a supplement which contains these same standardization ratios.
One interesting clinical trial on natural alternatives to ADHD medications, with U.S. military soldiers as trial participants, found that caffeine consumption reduced ADHD symptoms and improved cognitive performance in patients with ADHD.
Caffeine is a milder stimulant than amphetamine, which explains why it may be effective for reducing ADHD symptoms.
We do not recommend stopping use of atomoxetine and using either of these OTC compounds as replacements without a doctor’s approval.
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.
Drugs.com is a website where users of prescription medication can submit reviews of their experience. While we cannot verify the authenticity or validity of any of these reviews, we consider the site a useful resource.
The top positive review of atomoxetine is written by a user named “Juicey J” who gives the drug a 9/10 rating. They claim that the medication significantly improve their quality of life:
“The side effects only lasted around 2 weeks...then came the good part. All these side effects subsided and I noticed how calm I was. Usually I'm on edge. I also noticed I'm more attentive to the things I need to take care of at home and work. And I enjoy sex more than I did before, and I'm sure this med has helped me become closer with my fiance again. If you are suffering with ADHD and don't like stimulants, please give this med a chance. It is well worth it!”
The top negative review is published by an anonymous user who gives the drug a 2/10 rating, and claims it caused significant side effects:
“I'm 33 years old. Never been treated for ADHD before now. I have terrible anxiety among other things. Today is day three on [atomoxetine]. I feel drunk when I take it. I don't like alcohol normally. But this feels like I drank too much. The first few hours are difficult. My chest feels heavy and my body is tingling. I have constant goosebumps.”