Atomoxetine Discontinuation and Gastrointestinal Symptoms
Abruptly stopping atomoxetine does not typically cause nausea and vomiting as withdrawal symptoms. 1
Evidence on Atomoxetine Discontinuation
The most robust evidence comes from prospective, placebo-controlled studies specifically designed to assess discontinuation effects:
In four large studies involving both children and adults with ADHD, abrupt discontinuation of atomoxetine after 9-10 weeks of continuous therapy showed no statistically significant differences in discontinuation-emergent adverse events compared to patients continuing on placebo. 1
The incidence of discontinuation-emergent adverse events was low, and atomoxetine discontinuation did not result in an acute discontinuation syndrome. 1
Tapering of doses is not necessary when atomoxetine is discontinued, as it appears to be well tolerated without risk for discontinuation-emergent adverse effects. 1
Important Context About Nausea and Atomoxetine
While nausea and vomiting are not withdrawal symptoms from stopping atomoxetine, they are common adverse effects during active treatment:
Nausea and vomiting are among the most common adverse events reported during atomoxetine therapy itself in children and adolescents. 2
In adults, nausea is one of the most frequently reported adverse events during active treatment. 3
In overdose situations, vomiting can occur (6 out of 17 cases in one case series), but this is related to acute toxicity, not withdrawal. 4
What Actually Happens Upon Discontinuation
ADHD symptoms worsen following drug discontinuation but do not return to pretreatment levels (no symptom rebound). 1
Clinical Pitfalls to Avoid
Do not confuse adverse effects during active treatment (where nausea/vomiting are common) with discontinuation symptoms (where they are not). 2, 1
Unlike some antidepressants, which can cause nausea during withdrawal, atomoxetine does not share this discontinuation profile despite both affecting monoamine neurotransmitters. 2, 1
If a patient experiences nausea after stopping atomoxetine, consider alternative causes rather than attributing it to withdrawal. 1