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# 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

- Class: [ADHD medicines](https://durgical.com/en/pharmacology/classes/adhd-medicines/)
- Transporter: Noradrenaline transporter (NET)
- ATC code: N06BA09

⇄**Noradrenaline transporter (NET)**Atomoxetine

ⓘ The figure shows atomoxetine in the human noradrenaline transporter (outward-open state).

**Target in 3D:** Noradrenaline transporter (NET). PDB structure 8ZP2 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8ZP2) · Drag to rotate · pinch to zoom

## 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

### Serious (rare, important)

- Suicidal thoughts in children and adolescents (boxed warning)
- Rare severe liver injury
- Sudden death in people with structural heart disease
- Mania or psychotic symptoms

## 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.

## Memory aid

ATOMoxetine = «A Total Of Monoamine: noradrenaline only»: one transporter (NET), no stimulant high, but watch mood and liver.

## 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.

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## Related drugs

- [Methylphenidate](https://durgical.com/en/pharmacology/methylphenidate/)
- [Amfetamine](https://durgical.com/en/pharmacology/amfetamine/)

[← Back to the class: ADHD medicines](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0ab8d905-e890-4e91-a730-3e5d12f5c23f) (DailyMed (U.S. National Library of Medicine), 2026); [Atomoxetine: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a603013.html) (MedlinePlus (U.S. National Library of Medicine), 2026).

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Representative model, for educational purposes only.

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