Discontinuing Atomoxetine (Strattera)
Atomoxetine can be safely discontinued without tapering, as it does not produce a discontinuation syndrome and can be stopped abruptly without risk for symptom rebound or discontinuation-emergent adverse effects. 1
Discontinuation Protocol
- Atomoxetine capsules can be discontinued without being tapered 2
- Unlike many other psychiatric medications, atomoxetine does not require a gradual dose reduction schedule 1
- Studies have shown that abrupt discontinuation of atomoxetine does not result in the development of an acute discontinuation syndrome and is well tolerated 1
Clinical Considerations During Discontinuation
- While ADHD symptoms may worsen following drug discontinuation, they typically do not return to pretreatment levels 1
- The incidence of discontinuation-emergent adverse events is low with no statistically significant differences between patients abruptly discontinuing atomoxetine and those continuing on placebo 1
- Modest increases in heart rate and blood pressure that may have occurred during treatment gradually decrease on cessation of treatment 3, 4
Monitoring After Discontinuation
- Patients should be monitored for recurrence of ADHD symptoms after discontinuation 5
- Periodic reassessment is recommended to determine whether there is a continued need for medication treatment 5
- Clinical guidelines support periodically assessing patients with ADHD, potentially including a medication-free interval, to determine whether continued treatment is necessary 5
Special Populations
- The same discontinuation approach applies to both children and adults 1
- For patients with hepatic insufficiency, no special discontinuation protocol is needed, though they may have had different dosing requirements during treatment 2
- For poor CYP2D6 metabolizers or patients taking strong CYP2D6 inhibitors, the same abrupt discontinuation approach is appropriate, though they may have experienced different adverse event profiles during treatment 2
Contrast with Other Psychiatric Medications
- Unlike many antidepressants which commonly cause discontinuation symptoms (insomnia, flu-like symptoms, mood disturbances, dizziness, and paresthesias) 6, atomoxetine does not produce these effects
- Unlike benzodiazepines which require gradual tapering to prevent withdrawal symptoms 5, atomoxetine can be stopped abruptly
- Unlike antipsychotics which should be withdrawn gradually to minimize discontinuation effects such as dyskinesias and parkinsonian symptoms 5, atomoxetine does not require tapering
Important Clinical Caveat
- While atomoxetine itself doesn't require tapering, clinicians should still evaluate the need for continued ADHD treatment 5
- If discontinuing atomoxetine to switch to another ADHD medication, no washout period is required before starting stimulants, but a 2-week washout is required if switching to an MAOI 2