Atomoxetine (Strattera)

Probably yes; it just hasn't kicked in yet. A week is very early for atomoxetine. The medication needs several weeks to build up to a level where you'll notice a difference. Around half of people who will eventually respond notice their first real improvement at around 3–4 weeks. Give it at least 12 weeks before you draw any conclusions. In the meantime, keeping a short weekly note of how things are going can help you spot the gradual improvement that might otherwise go unnoticed.

Not necessarily. In UK practice, atomoxetine is often tried after stimulants: but there are many valid reasons to start with atomoxetine directly. These include: preference for a non-controlled drug, medications that interact with stimulants, specific health conditions, comorbid anxiety, or a history of substance use. Your prescriber will discuss which option makes most sense for your situation.

It depends which one. Some antidepressants: particularly fluoxetine (Prozac) and paroxetine (Seroxat): slow down the enzyme that processes atomoxetine. This can cause your atomoxetine level to become 5–7 times higher than expected at a standard dose. This doesn't mean you can't take them together; it means your prescriber needs to know and will start you on a lower dose of atomoxetine. Always give your full medication list before starting. One antidepressant that must never be combined with atomoxetine: MAOIs (e.g., phenelzine, tranylcypromine, or high-dose selegiline). There must be at least 14 days between stopping an MAOI and starting atomoxetine. This combination can cause a dangerous spike in blood pressure.

No. Atomoxetine is not a stimulant and not a controlled drug. Standard workplace, occupational health, or forensic drug screening tests look for controlled substances: and atomoxetine is not one of them. It will not cause a positive result.

Yes, and there is specific clinical evidence that atomoxetine helps with both. In a large randomised trial, atomoxetine significantly improved anxiety symptoms alongside ADHD symptoms. Some stimulants can worsen anxiety in certain people: atomoxetine doesn't have this profile. Let your prescriber know about your anxiety so they can factor it in.

Usually not: and often it improves it. In a head-to-head study, people on atomoxetine fell asleep in an average of 12 minutes, compared to 39 minutes for people on methylphenidate. If stimulant medication has been making it hard to get to sleep, this is a real advantage. You can also take an evening dose (if on split dosing) without it disrupting sleep the way a stimulant would.

Alcohol isn't an absolute no with atomoxetine, but there are two things worth knowing. Both alcohol and atomoxetine affect blood pressure: their effects can add together, so heavy drinking can increase cardiovascular strain. Atomoxetine is also processed by the liver, and alcohol adds to the burden on your liver: atomoxetine carries a rare but real risk of liver problems, so heavy alcohol use on top of this isn't a good combination. Moderation is strongly advisable. If you have ADHD and also find alcohol use difficult, tell your prescriber: there's actually some positive evidence that atomoxetine can help reduce heavy drinking days for people with both conditions.

Take it as soon as you remember, unless it's nearly time for your next scheduled dose: in which case skip it and continue as normal. Don't double up. An occasional missed dose won't cause a rebound effect, but consistent daily dosing gives you the most stable coverage.

Yes. Atomoxetine works by maintaining a steady level in your system: it's not something you take only on days when you need to focus. Taking 'medication holidays' as some people do with stimulants isn't appropriate with atomoxetine. Daily dosing is what keeps the therapeutic effect stable.

Tell your prescriber before stopping or continuing atomoxetine. The current evidence (BUMPS, December 2022) doesn't show that atomoxetine causes birth defects, but the data is limited. If taken close to delivery, a baby may have some withdrawal symptoms (jitteriness, difficulty feeding). Breastfeeding: there is no published human data on atomoxetine in breast milk. There is a risk of drowsiness in your baby and, in some babies, a risk of the medication building up in their system (particularly if your baby processes CYP2D6 slowly). This needs an individual review with your specialist: speak to your prescriber before deciding either way. Do not stop atomoxetine without talking to your prescriber or midwife first.