Atomoxetine Dosing for Adolescents
For adolescents, atomoxetine (Strattera) should be initiated at 0.5 mg/kg/day and increased after a minimum of 3 days to a target dose of 1.2 mg/kg/day, with a maximum dose of 1.4 mg/kg/day or 100 mg daily (whichever is less). 1
Initial Dosing
For adolescents weighing ≤70 kg:
- Starting dose: 0.5 mg/kg/day
- Target dose: 1.2 mg/kg/day
- Maximum dose: 1.4 mg/kg/day or 100 mg daily (whichever is less)
For adolescents weighing >70 kg:
- Starting dose: 40 mg/day
- Target dose: 80 mg/day
- Maximum dose: 100 mg/day
Administration Schedule
- Can be administered either as a single daily dose in the morning or divided into two evenly spaced doses (morning and late afternoon/early evening) 1
- May be taken with or without food 1
- Capsules should be taken whole, not opened 1
Dose Titration
- Increase dose after a minimum of 3 days on initial dose 1
- If symptom control is not achieved at target dose, may increase to maximum dose after 2-4 additional weeks 1
- No additional benefit has been demonstrated for doses higher than 1.2 mg/kg/day 1, 2
Special Considerations
- For patients with moderate hepatic impairment (Child-Pugh Class B), initial and target doses should be reduced to 50% of the normal dose 1
- Poor metabolizers of CYP2D6 (approximately 7% of population) may require lower doses due to higher plasma levels and increased side effects 3
- Monitor closely for cardiovascular effects, including increased heart rate and blood pressure 3
Monitoring
- Monitor vital signs, height, and weight regularly 4, 3
- Assess for common side effects: nausea, vomiting, fatigue, decreased appetite, abdominal pain, and somnolence 3, 5
- Screen for suicidal ideation, especially during the first few months of treatment 3
- Follow up at least monthly until symptoms have stabilized 4
Efficacy Considerations
- Atomoxetine has a delayed onset of full therapeutic effect compared to stimulants 3
- Clinical trials have shown that 1.2 mg/kg/day is as effective as 1.8 mg/kg/day and should be the appropriate initial target dose for most patients 2
- Unlike stimulants, atomoxetine can be discontinued without tapering 3, 1
Atomoxetine is particularly useful for adolescents with ADHD who are at risk for substance abuse or who have comorbid anxiety or tics 5, 6. However, it's important to note that atomoxetine is generally less effective than extended-release methylphenidate formulations and extended-release mixed amphetamine salts 5, 6.