Drug Class of Strattera (Atomoxetine)
Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor (SNRI), specifically classified as a selective norepinephrine reuptake inhibitor rather than a stimulant medication. 1, 2
Mechanism of Action
Atomoxetine works by:
- Selectively inhibiting the presynaptic reuptake of norepinephrine in the brain 3
- Having high affinity and selectivity for norepinephrine transporters
- Having little to no affinity for various other neurotransmitter receptors 3
- Preferentially binding to areas with high distribution of noradrenergic neurons, particularly in the fronto-cortical subsystem 3
Classification Clarification
While atomoxetine is technically classified under the broader SNRI category in some contexts, it's important to note that:
- It is more precisely described as a selective norepinephrine reuptake inhibitor 2, 1
- Unlike traditional SNRIs (venlafaxine, duloxetine, desvenlafaxine, levomilnacipran) that affect both serotonin and norepinephrine, atomoxetine is more selective for norepinephrine 4
- The American Academy of Child and Adolescent Psychiatry (AACAP) distinguishes atomoxetine from other SNRIs, noting that "atomoxetine (a selective norepinephrine reuptake inhibitor) also was included in the AHRQ/Mayo review under the SNRI class; however, at present, the effectiveness of atomoxetine for the treatment of anxiety as the primary disorder has not been established" 4
Clinical Applications
Atomoxetine is FDA-approved for:
- Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents, and adults 2, 3
- It is not approved or established for the treatment of anxiety disorders 4
Key Distinctions from Other Medications
Unlike stimulant medications for ADHD, atomoxetine:
- Is not classified as a controlled substance 3, 5
- Has negligible risk of abuse or misuse 3, 6
- Can be particularly useful for patients at risk of substance abuse 3, 7
- May be beneficial for patients with comorbid anxiety or tics 6
Pharmacological Properties
- Can be administered as a single daily dose or split into two evenly divided doses 3
- Undergoes extensive biotransformation affected by CYP2D6 metabolism 3
- Approximately 7% of the population are CYP2D6 poor metabolizers, who may experience higher plasma levels and longer half-lives 2
In summary, while atomoxetine may sometimes be grouped with SNRIs in broader classifications, it is more accurately described as a selective norepinephrine reuptake inhibitor with specific applications for ADHD treatment.