Atomoxetine !
A non-stimulant for ADHD that selectively blocks noradrenaline reuptake. Not a controlled substance, so its abuse risk is low.
Updated 2026-11-01
The figure shows atomoxetine in the human noradrenaline transporter (outward-open state).
Mechanism of action
Atomoxetine selectively blocks the presynaptic noradrenaline transporter. In the prefrontal cortex, where dopamine is also cleared by this transporter, both noradrenaline and dopamine rise, improving attention; it does not raise dopamine in reward circuits, so it has little abuse potential.
- Atomoxetine selectively blocks NET
- Prefrontal noradrenaline and dopamine rise
- Attention and impulse control improve
- No dopamine rise in reward circuits: little abuse
Pharmacokinetics
- Absorption
- Taken by mouth (capsules)
- Metabolism
- Liver, by CYP2D6: poor metabolisers and people on CYP2D6 inhibitors have much higher levels
Indications
- Attention-deficit/hyperactivity disorder (ADHD) in children aged 6 and older and adults
Adverse effects
Common
- Nausea, reduced appetite and abdominal pain
- Sleepiness or insomnia
- Raised heart rate and blood pressure
- Urinary hesitancy and sexual dysfunction in adults
Contraindications
- Use of an MAO inhibitor now or within the previous 14 days
- Narrow-angle glaucoma
- Pheochromocytoma
- Severe heart or vascular disease that a rise in blood pressure or heart rate would worsen
- Hypersensitivity to atomoxetine
Key interactions
- MAO inhibitors (including linezolid and intravenous methylene blue)
- Contraindicated
- Strong CYP2D6 inhibitors (fluoxetine, paroxetine)
- Much higher atomoxetine levels
- Salbutamol and other β2 agonists
- Larger rises in heart rate and blood pressure
What is monitored
- Mood and suicidal thoughts, especially in the first months and after dose changes
- Blood pressure and heart rate
- Signs of liver injury (dark urine, jaundice, itching, right upper abdominal pain)
- Height and weight in children
Administration and safety
- Capsules are not meant to be opened; the contents irritate the eyes
- Not a controlled substance, unlike stimulants
Nursing care
- Teaches the family to watch for changes in mood, agitation or suicidal talk and to report them at once
- Measures blood pressure and heart rate at baseline, after dose changes and periodically
- Teaches the signs of liver injury
Pregnancy and breastfeeding
Human data are limited; use in pregnancy weighs the benefit for the mother against possible risks to the fetus.
Test yourself
Think of the answer, then tap the question to see it.
Why does atomoxetine have little abuse potential?
It blocks only the noradrenaline transporter and does not raise dopamine in the reward circuits.
Which boxed warning does atomoxetine carry?
Increased risk of suicidal thoughts in children and adolescents.
Why can fluoxetine markedly raise atomoxetine levels?
Fluoxetine strongly inhibits CYP2D6, the enzyme that metabolises atomoxetine.
Related drugs
← Back to the class: ADHD medicines
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - ATOMOXETINE capsule (DailyMed (U.S. National Library of Medicine), 2026); Atomoxetine: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026).
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Representative model, for educational purposes only.