Can Straterra (atomoxetine) cause delayed ejaculation?

Strattera (Atomoxetine) and Delayed Ejaculation

Yes, Strattera (atomoxetine) can cause delayed ejaculation and other ejaculatory dysfunction, and this is a well-documented adverse effect in the FDA drug label. 1

Evidence from FDA Drug Label

The FDA label for atomoxetine explicitly lists ejaculatory dysfunction as a common adverse effect:

• Ejaculation delayed and/or ejaculation disorder occurred in 4% of atomoxetine-treated adult males versus 1% on placebo in controlled trials 1
• Erectile dysfunction occurred in 8% of atomoxetine-treated adult males versus 1% on placebo 1
• These sexual side effects are likely underestimated because patients and physicians are often reluctant to discuss sexual dysfunction, and most clinical trials do not systematically assess these problems 1

Poor Metabolizers at Higher Risk

Men who are CYP2D6 poor metabolizers experience significantly higher rates of sexual dysfunction with atomoxetine:

• Ejaculation disorder: 6% in poor metabolizers vs 2% in extensive metabolizers 1
• Erectile dysfunction: 21% in poor metabolizers vs 9% in extensive metabolizers 1
• Poor metabolizers have higher drug levels due to slower metabolism, leading to more pronounced side effects 1

Clinical Management According to Guidelines

If delayed ejaculation develops on atomoxetine, the 2022 AUA/SMSNA Guidelines recommend dose adjustment, medication replacement, or staged cessation of the offending medication 2

Management Algorithm:

1. Confirm the temporal relationship between atomoxetine initiation and onset of delayed ejaculation 2

2. Assess the severity and distress caused by the ejaculatory dysfunction - men with ejaculatory latencies beyond 25-30 minutes who report distress qualify for delayed ejaculation diagnosis 2

3. Consider dose reduction first if ADHD control allows, as sexual side effects are dose-dependent 1

4. If dose reduction is insufficient, switch to an alternative ADHD medication that does not cause delayed ejaculation 2

5. Refer to mental health professional with sexual health expertise if the delayed ejaculation persists or causes significant relationship distress 2

Important Clinical Pitfall

Do not confuse atomoxetine's effect with SSRIs used to treat premature ejaculation. While SSRIs like sertraline and paroxetine are intentionally used to delay ejaculation in men with premature ejaculation 3, 4, 5, atomoxetine causes this as an unwanted side effect. The mechanism differs - SSRIs work through serotonergic pathways 6, 5, while atomoxetine is a norepinephrine reuptake inhibitor 2.

Patient Counseling

Physicians should routinely inquire about sexual side effects when prescribing atomoxetine, as the FDA label specifically notes that sexual dysfunction is poorly assessed in clinical trials and patients may be reluctant to report these symptoms 1. The actual incidence is likely higher than reported rates 1.