Strattera Tapering Guide
atomoxetine
Boxed Warning
Increased risk of suicidal ideation in children, adolescents, and young adults with ADHD or other psychiatric disorders. Monitor closely during initial therapy and dose changes.
Overview
Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. It is the first non-stimulant medication approved for ADHD.
10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg
Capsules: 10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg
Category C (risk cannot be ruled out)
Mechanism of Action
Selective inhibitor of the presynaptic norepinephrine transporter (NET), increasing synaptic norepinephrine. Minimal affinity for other neurotransmitter transporters or receptors.
Taper Notes
Atomoxetine has a relatively short half-life and dose-dependent withdrawal is uncommon, but rebound ADHD symptoms, fatigue, and mood changes can occur. Step down by available capsule strengths.
Hyperbolic Tapering Guidance
Atomoxetine is generally easier to discontinue than SSRIs because dependence is uncommon, but stepwise reductions matched to capsule strengths help blunt rebound symptoms. CYP2D6 poor metabolizers may experience prolonged effects and should taper more slowly.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Tapering Protocol
Evidence-based phased reduction schedule. Always taper under medical supervision.
| Phase | Duration | Notes |
|---|---|---|
| Initial reductions | 2-3 weeks | Step down using available capsule strengths (e.g., 80 → 60 → 40mg). Most extensive metabolizers tolerate larger early steps. |
| Middle reductions | 2-3 weeks | Continue stepwise reductions. Monitor for rebound ADHD symptoms and mood changes. |
| Final reductions | 2-4 weeks | Lowest capsule (10mg) to off. Poor CYP2D6 metabolizers may benefit from longer holds at this stage. |
Withdrawal Timeline
1-3 days after dose reduction
3-7 days
Most rebound symptoms resolve within 1-2 weeks
Rebound ADHD symptoms and low mood may persist 2-4 weeks; uncommon beyond that
Community Tips
Practical insights shared by members tapering Strattera. Not medical advice — always consult your prescriber.
- 1Atomoxetine is generally easier to come off than SSRIs — most members find a 2-4 week stepdown by capsule strength sufficient.
- 2If you are a known CYP2D6 poor metabolizer or take a strong CYP2D6 inhibitor (paroxetine, fluoxetine), expect a slower clearance and plan a longer taper.
- 3Watch for rebound focus and mood difficulties — these mimic untreated ADHD but typically resolve within a couple of weeks.
- 4Splitting the daily dose to twice daily before stepping down can soften the transition for some members.
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- MAOIs — contraindicated within 14 days (hypertensive crisis risk)
- Strong CYP2D6 inhibitors (paroxetine, fluoxetine, quinidine) markedly increase exposure
- Albuterol and other beta-agonists may potentiate cardiovascular effects
Food Interactions
- No clinically significant food effect on AUC
- Food may reduce nausea associated with the morning dose
Contraindications
- Concurrent or recent (within 14 days) MAOI use
- Narrow-angle glaucoma
- Pheochromocytoma
Toxicity
Suicidal ideation in pediatric patients, severe hepatic injury (rare), and increased blood pressure/heart rate. Risk of QT prolongation in poor metabolizers or with CYP2D6 inhibitors.
Pharmacokinetics
ADME Profile
Rapidly absorbed after oral administration, Tmax 1–2 hours. Bioavailability 63% in extensive metabolizers, 94% in poor metabolizers. Food may delay Tmax but does not affect overall exposure.
~0.85 L/kg
Extensive hepatic metabolism, primarily via CYP2D6 to 4-hydroxyatomoxetine (active, but rapidly glucuronidated). Minor contributions from CYP2C19.
Renal (>80% as conjugated 4-hydroxyatomoxetine), <3% unchanged.
~98% (primarily albumin)
~0.35 L/h/kg (extensive metabolizers); ~0.03 L/h/kg (poor metabolizers)
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Other Drug Profiles
Sources & References
Strattera (atomoxetine) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Regulatory sources
Official prescribing information and safety notices.
Peer-reviewed research
Primary literature cited in this taper guide.
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
- Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)
- Framer A 2021 — The patient voice: an exploration of the experience of withdrawal from antidepressants (Therapeutic Advances in Psychopharmacology)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.