Strattera (Atomoxetine) Discontinuation
Atomoxetine can be discontinued abruptly without tapering, as it does not cause withdrawal symptoms or symptom rebound. 1
Discontinuation Protocol
Stop atomoxetine immediately without dose reduction. The FDA label explicitly states that "atomoxetine capsules can be discontinued without being tapered." 1 This is based on prospective, placebo-controlled studies demonstrating that abrupt discontinuation after 9-10 weeks of continuous therapy does not produce a discontinuation syndrome. 2
What to Expect After Stopping
- ADHD symptoms will gradually worsen but do not rebound below pretreatment baseline levels 2
- No withdrawal symptoms occur - the incidence of discontinuation-emergent adverse events is statistically identical to placebo 2
- Cardiovascular changes resolve gradually - modest increases in heart rate and blood pressure that occurred during treatment decrease after cessation 3
Key Differences from Other Psychiatric Medications
This straightforward discontinuation contrasts sharply with other psychiatric medications:
- Antidepressants (including duloxetine, which is also used for ADHD) require tapering over at least 2-4 weeks when used longer than 3 weeks 4
- Benzodiazepines require very gradual tapers extending over many weeks to months to prevent withdrawal seizures and rebound symptoms 4
- Antipsychotics need gradual withdrawal over more than 1 month to minimize dyskinesias, parkinsonian symptoms, and neuroleptic malignant syndrome 4
Clinical Considerations
Monitor for Symptom Return
Watch for gradual return of ADHD symptoms over days to weeks, not acute withdrawal effects. 2 The medication's therapeutic effects will wear off as plasma levels decline, but this represents loss of efficacy rather than a discontinuation syndrome. 5, 2
No Special Precautions Needed
- No need for clonidine or adjuvant treatments for withdrawal management (unlike opioid discontinuation) 4
- No need for close observation during the discontinuation period specifically for withdrawal effects 2
- No risk of seizures from abrupt cessation (unlike benzodiazepines, baclofen, or barbiturates) 4
When Immediate Discontinuation Is Appropriate
Stop atomoxetine immediately if:
- Suicidal ideation emerges (black-box warning for increased risk in children/adolescents) 1, 5
- Signs of serious liver injury develop 5
- Severe cardiovascular reactions occur 1
- Hypersensitivity reactions manifest 1
Common Pitfall to Avoid
Do not unnecessarily taper atomoxetine like you would other psychiatric medications. 1, 2 The evidence clearly demonstrates that tapering provides no benefit and only delays the return to baseline ADHD symptom levels. This is unique among ADHD medications and psychiatric drugs in general. 2, 6