Can You Use Strattera (Atomoxetine) with Cocaine?
Yes, atomoxetine can be used with cocaine and appears to be safe based on available evidence, though it does not prevent cocaine use or reduce cocaine-seeking behavior in clinical practice. 1, 2, 3
Safety Profile of the Combination
The combination of atomoxetine and cocaine has been specifically studied in controlled clinical settings with reassuring safety data:
Cardiovascular effects are generally well-tolerated: In a double-blind study of 20 cocaine-dependent volunteers receiving atomoxetine 80-100 mg daily with intravenous cocaine (20-40 mg), all participants tolerated the combination safely without serious adverse events 1
Blood pressure changes are modest: Atomoxetine caused small but statistically significant increases in baseline systolic and diastolic pressures, but when combined with cocaine, atomoxetine actually attenuated the systolic pressure increases caused by cocaine 1, 2
No electrocardiogram abnormalities: All ECG parameters remained unchanged during combined use 1
No pharmacokinetic interactions: Atomoxetine does not alter cocaine metabolism or blood levels, meaning cocaine's effects are not unexpectedly enhanced or prolonged 1, 2
Key Mechanistic Differences from Beta-Blockers
Atomoxetine is fundamentally different from beta-blockers and does not carry the same risks seen with cocaine-beta-blocker combinations:
Atomoxetine is a selective norepinephrine reuptake inhibitor, not a beta-blocker 4
Unlike beta-blockers (which are contraindicated in acute cocaine intoxication due to unopposed alpha-stimulation causing coronary vasospasm), atomoxetine does not block adrenergic receptors 5
Animal studies show inconsistent stimulus generalization between atomoxetine and cocaine, and atomoxetine lacks stimulant or euphoriant properties 4
Clinical Efficacy Considerations
While safe, atomoxetine has limited utility for treating cocaine dependence:
Does not reduce cocaine use: A 12-week randomized controlled trial (n=50) found no difference between atomoxetine 80 mg/day and placebo in reducing cocaine-positive urine samples or improving retention in treatment 3
May reduce subjective effects: Atomoxetine decreased Visual Analog Scale scores for "bad effect" and "likely to use" after cocaine administration, and lowered Addiction Research Center Inventory scores for amphetamine, euphoria, and energy subscales 1
Potential cognitive benefits: Atomoxetine improved performance on visual n-back working memory tasks in cocaine users 1
Clinical Management Approach
For patients prescribed atomoxetine who use cocaine:
Continue atomoxetine as prescribed; there is no need to discontinue based on safety concerns 1, 2
Monitor blood pressure, as atomoxetine may cause modest baseline increases that are additive with cocaine's effects 1
Counsel patients that atomoxetine will not block cocaine's effects or reduce cravings 3
For patients with acute cocaine intoxication:
Do NOT confuse atomoxetine with beta-blockers—atomoxetine does not require the same precautions 4
If treating cocaine-induced cardiovascular toxicity, use benzodiazepines, nitroglycerin, or calcium channel blockers as first-line agents 5
Avoid beta-blockers (or use combined alpha-beta blockers like labetalol only after vasodilator administration) due to risk of coronary vasospasm 5
Important Caveats
The safety data comes from controlled research settings with monitored cocaine administration; real-world scenarios with variable cocaine purity, doses, and routes of administration may differ 1, 2
Atomoxetine is not a controlled substance and has no abuse potential, making it distinct from stimulant ADHD medications 4
While atomoxetine is safe with cocaine, it should not be considered a treatment for cocaine dependence given the lack of efficacy in reducing cocaine use 3