Classifications: psychotherapeutic agent, miscellaneous;
Therapeutic: adhd agent

Pregnancy Category: C


10 mg, 18 mg, 25 mg, 40 mg, 60 mg capsules


Exact mechanism of action is unknown, but is thought to be related to selective inhibition of the pre-synaptic norepinephrine transporter, resulting in norepinephrine reuptake inhibition.

Therapeutic Effect

Improved attentiveness, ability to follow through on tasks with less distraction and forgetfulness, and diminished hyperactivity.


Treatment of attention deficit/hyperactivity disorder (ADHD) in adults and children.


Hypersensitive to atomoxetine or any of its constituents; concomitant use or use within 2 wk of MAOIs; narrow angle glaucoma; jaundice; suicidal ideation; pregnancy (category C).

Cautious Use

Severe liver injury may progress to liver failure or death in a small percentage of patients. Hypertension, tachycardia, cardiovascular or cerebrovascular disease; any condition that predisposes to hypotension; urinary retention or urinary hesitancy; concomitant use of CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine), albuterol or other beta-2 agonists, vasopressor drugs; history of bipolar disorder. Safety and efficacy in children <6 y and the older adult have not been established; lactation.

Route & Dosage

Adult: PO Start with 40 mg in morning. May increase after 3 d to target dose of 80 mg/d given either once in the morning or divided morning and late afternoon/early evening. May increase to max of 100 mg/d if needed.
Child/Adolescent: PO <70 kg, start with 0.5 mg/kg/d. May increase after 3 d to target dose of 1.2 mg/kg/d. Administer once daily in morning or divide dose and give morning and late afternoon/early evening. Max dose is 1.4 mg/kg or 100 mg, whichever is less. >70 kg, the max total daily dose is 100 mg.

Hepatic Impairment
Child-Pugh Class B: Initial and target doses should be reduced to 50% of the normal dose.
Child-Pugh Class C: Initial dose and target doses should be reduced to 25% of normal.


  • Note that total daily dose in children and adolescents is based on weight. Determine that ordered dose is appropriate for weight prior to administration of drug.
  • Note manufacturer recommends dosage adjustments with concomitant administration of strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine). Consult physician.
  • Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Flu-like syndrome, flushing, fatigue, fever, rigors. CNS: Dizziness, headache, somnolence, crying, tearfulness, irritability, mood swings, insomnia, depression, tremor, early morning awakenings, paresthesias, abnormal dreams, decreased libido, sleep disorder, suicidal ideation. CV: Increased blood pressure, sinus tachycardia, palpitations. GI: Upper abdominal pain, constipation, dyspepsia, vomiting, decreased appetite, anorexia, dry mouth, diarrhea, flatulence, severe liver injury (rare). Endocrine: Hot flushes. Metabolic: Weight loss. Hepatic: Hepatotoxicity. Musculoskeletal: Arthralgia, myalgia. Respiratory: Cough, rhinorrhea, nasal congestion, sinusitis. Skin: Dermatitis, pruritus, increased sweating. Special Senses: Mydriasis. Urogenital: Urinary hesitation/retention, dysmenorrhea, ejaculation dysfunction, impotence, delayed onset of menses, irregular menstruation, prostatitis.


Drug: Albuterol may potentiate cardiovascular effects of atomoxetine; fluoxetine, paroxetine, quinidine may increase atomoxetine levels and toxicity; maois may precipitate a hypertensive crisis; may attenuate effects of antihypertensive agents.


Absorption: Well absorbed from GI tract. Peak: 1–2 h. Metabolism: In liver by CYP2D6. Elimination: Primarily in urine. Half-Life: 5.2 h.

Nursing Implications

Assessment & Drug Effects

  • Evaluate for continuing therapeutic effectiveness especially with long-term use.
  • Monitor children and adolescents for behavior changes that may indicate suicidal ideation.
  • Monitor cardiovascular status especially with preexisting hypertension.
  • Monitor HR and BP at baseline, following a dose increase, and periodically while on therapy.
  • Lab tests: Periodic LFTs.
  • Report increased aggression and irritability as these may indicate a need to discontinue the drug.

Patient & Family Education

  • Instruct patients on S&S of liver toxicity.
  • Report any of the following to physician: chest pains or palpitations, urinary retention or difficulty initiating voiding urine, appetite loss and weight loss, or insomnia.
  • Make position changes slowly if you experience dizziness with arising from a lying or sitting position.
  • Do not drive or engage in potentially hazardous activities until reaction to the drug is known.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

© 2006-2018 Last Updated On: 03/13/2018 (0)
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