Drug reference

Atomoxetine

Selective noradrenaline reuptake inhibitor (non-stimulant ADHD) · Attention-Deficit Hyperactivity Disorder (ADHD) medication

Also known as Atomoxetine Hydrochloride, Strattera, Attentrol, Axura, Tomoxetin

START

Adults 40 mg/day ≥3 days → 80 mg/day; paeds 0.5 → 1.2 mg/kg/day

TYPICAL MAX

100 mg/day (or 1.4 mg/kg/day paeds)

STOP IF

Suicidal ideation, hepatotoxicity (jaundice/dark urine/↑LFTs), serious cardiac symptoms

WATCH

Mood/suicidality (esp. early, paeds), HR/BP, growth in children, hepatic symptoms

CDSCO approvedSchedule HATC N06BA09

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1.5h · absorption
PEAK: 1.5h · Cmax
t½: 5h · t½ (EM; ~22 h PM)
DURATION: 1d · once-daily

EXCRETION

Hepatic CYP2D6; >80% renal metabolites

route + CYP

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Use only if clearly needed — limited human data

FDA category + note

Top interactionssee all 12 →

MoclobemideContraindicatedTextbookKDT 7e · p487
MaoisContraindicatedDatabaseKimi deep-research + Cla
TapentadolSevereTextbookG&G 14e · p462
AmiodaroneSevereDatabaseDDInter

Available in India

46 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Selective inhibition of the presynaptic noradrenaline transporter, increasing noradrenaline (and dopamine in prefrontal cortex) — improves attention/impulse control without classical stimulant abuse potential.

Indications

Attention-deficit/hyperactivity disorder (children ≥6 years, adolescents, adults)

Dosing

Adult: 40 mg/day for ≥3 days then 80 mg/day; max 100 mg/day. Children/adolescents ≤70 kg: start 0.5 mg/kg/day, target ~1.2 mg/kg/day (max 1.4 mg/kg or 100 mg).
Pediatric: As above (≥6 years).
Renal adjustment: No adjustment.
Hepatic adjustment: Child-Pugh B: 50% of normal dose. Child-Pugh C: 25%.
Geriatric: Not established.
Max dose: 100 mg/day (adult); 1.4 mg/kg/day (paeds ≤70 kg)

Pharmacokinetics

Onset

Clinical benefit over 2–4+ weeks

Peak effect

Cmax ~1–2 h

Duration

Once–twice daily dosing

Half-life

~5 h (extensive metabolisers); ~22 h (CYP2D6 poor metabolisers)

Bioavailability

~63% EM; ~94% PM

Protein binding

~98%

Metabolism

Hepatic CYP2D6 (major) to 4-hydroxyatomoxetine

Excretion

Renal (>80%, as conjugated metabolites)

Contraindications

MAOI use within 14 days
Narrow-angle glaucoma
Phaeochromocytoma
Severe cardiovascular disease (structural cardiac/serious arrhythmia)
Hypersensitivity to atomoxetine

Side effects

Common

Decreased appetite, nausea, dyspepsiaDry mouth (adults)Insomnia, somnolenceIncreased heart rate/BPErectile dysfunction (adults)

Serious

Suicidal ideation (children/adolescents — boxed)
Severe hepatotoxicity (rare)
Serious cardiovascular events (sudden death with structural cardiac disease)
Severe allergic reaction; priapism; psychotic/manic symptoms

Pregnancy & lactation

Pregnancy

Use only if clearly needed — limited human data

Lactation

Limited data; avoid or monitor infant

Drug interactions

Moclobemide

Contraindicated

Textbook

Increased risk of adverse effects due to potential synergistic actions on neurotransmitters.

Source: KDT 7e · p487

Maois

Contraindicated

Database

Risk of hypertensive crisis/serotonin-like reaction

Do not use within 14 days of an MAOI

Source: Kimi deep-research + Cla

Tapentadol

Severe

Textbook

Risk of serotonin syndrome.

Monitor closely for signs of serotonin syndrome. Avoid co-administration if possible.

Source: G&G 14e · p462

Amiodarone

Severe

Database