Restarting Strattera After Discontinuation
You do not need to restart Strattera (atomoxetine) at a low dose after stopping the medication. Unlike some medications that require dose re-titration after interruption, atomoxetine can generally be resumed at the previously effective dose without a mandatory restart at lower doses.
Dosing Guidance After Interruption
The standard approach is to resume at the same dose if the medication was previously well-tolerated. 1 The typical dosing for atomoxetine starts at 40 mg daily with titration every 7-14 days to 60 mg then 80 mg daily, with a maximum of 1.4 mg/kg/day or 100 mg/day. 1
Key Considerations for Resuming Treatment
- Short interruptions (1-2 missed doses): Resume at the same dose without adjustment 2, 3, 4
- Longer interruptions: Clinical judgment is required, but restarting at the previous therapeutic dose is generally appropriate if the patient tolerated it well previously 2, 3, 4
- No discontinuation syndrome: Atomoxetine is not associated with acute discontinuation syndrome or symptom rebound, which supports the ability to restart at therapeutic doses 5, 6
Important Distinctions from Other Medications
This differs significantly from medications like SSRIs (particularly paroxetine, fluvoxamine, and sertraline) which are associated with discontinuation syndrome and may require gradual re-titration. 1 Atomoxetine's pharmacological profile as a selective norepinephrine reuptake inhibitor does not carry the same risk. 2, 3, 4
Common Pitfalls to Avoid
- Do not confuse with GLP-1 agonists: Unlike semaglutide or liraglutide which require specific re-titration schedules after missing 2-3 doses, atomoxetine does not have this requirement 1
- Monitor for tolerability: While dose re-titration is not mandatory, assess for any changes in tolerability when restarting, particularly gastrointestinal symptoms and decreased appetite which are common side effects 2, 5, 6
- Consider duration of interruption: If treatment has been stopped for an extended period (weeks to months), some clinicians may prefer a brief re-titration period for tolerability, though this is not evidence-based 2, 3, 4
Practical Implementation
Resume atomoxetine at the previously effective dose (typically 60-100 mg daily) and monitor for response and tolerability over the first 1-2 weeks. 1 The medication demonstrates consistent efficacy without requiring dose escalation after interruption, and its lack of abuse potential means there are no concerns about tolerance development during treatment gaps. 2, 3, 4, 6