Atomoxetine Discontinuation
Atomoxetine does not require tapering and can be discontinued abruptly without risk of withdrawal symptoms or symptom rebound. 1, 2
FDA-Approved Discontinuation Protocol
The FDA label explicitly states that "Atomoxetine capsules can be discontinued without being tapered." 1 This is a clear directive that distinguishes atomoxetine from many other psychiatric medications.
Evidence Supporting Abrupt Discontinuation
A prospective, placebo-controlled study specifically evaluated discontinuation effects in children and adults with ADHD after 9-10 weeks of continuous atomoxetine therapy and found:
- No acute discontinuation syndrome developed 2
- No statistically significant differences in discontinuation-emergent adverse events between patients abruptly stopping atomoxetine versus those continuing on placebo 2
- ADHD symptoms worsened after discontinuation but did not return to pretreatment levels (no rebound effect) 2
- The incidence of discontinuation-emergent adverse events was low 2
- Tapering of doses is not necessary when atomoxetine is discontinued 2
Mechanism Explaining Safe Discontinuation
Unlike SSRIs and SNRIs, atomoxetine's selective norepinephrine reuptake inhibition does not produce the neuroadaptive changes that lead to withdrawal syndromes seen with serotonergic agents. 2, 3 This pharmacological profile allows for safe abrupt discontinuation without the somatic symptoms (dizziness, nausea, sensory disturbances) or psychological symptoms (anxiety, agitation) commonly seen with antidepressant discontinuation. 4, 5
Critical Distinction from Other Medications
While general pediatric psychopharmacology guidelines recommend gradual tapering for most psychiatric medications to avoid withdrawal symptoms or rebound worsening, 6 atomoxetine is a specific exception to this rule based on both FDA labeling and clinical trial evidence. 1, 2
This stands in stark contrast to:
- SSRIs, which require gradual tapering over months 7
- Benzodiazepines, which require careful tapering 6
- Antipsychotics, which may cause rebound symptoms if stopped abruptly 6
Practical Implementation
- Simply stop the medication at the current dose 1
- No dose reduction schedule is needed 2
- Monitor for return of ADHD symptoms, which represents the underlying condition rather than withdrawal 2
- Reassure patients and families that abrupt discontinuation is safe and expected 1, 2
Common Pitfall to Avoid
Do not confuse the return of baseline ADHD symptoms after stopping atomoxetine with a withdrawal syndrome—this represents the natural course of untreated ADHD, not a medication discontinuation effect. 2