How do I taper off Adderall (amphetamine and dextroamphetamine) and transition to Strattera (atomoxetine)?

Transitioning from Adderall to Strattera

Adderall (amphetamine/dextroamphetamine) does not require tapering and can be stopped abruptly when switching to Strattera (atomoxetine), which should be started at a low dose and titrated up gradually over 1-2 weeks.

Why Stimulants Don't Require Tapering

• Stimulant medications like Adderall work through acute dopamine and norepinephrine release rather than causing chronic receptor adaptations, so abrupt discontinuation does not produce a withdrawal syndrome 1
• While ADHD symptoms will return within hours to days after stopping stimulants, this represents symptom recurrence rather than withdrawal 1
• Unlike antidepressants or antipsychotics, stimulants do not require gradual dose reduction to avoid physiological withdrawal effects 1

Why Atomoxetine (Strattera) Doesn't Require Tapering Either

• Research specifically examining atomoxetine discontinuation found no discontinuation syndrome or withdrawal symptoms when stopped abruptly after 9-10 weeks of continuous therapy 2
• The incidence of discontinuation-emergent adverse events was low and not statistically different from placebo 2
• Tapering of doses is not necessary when atomoxetine is discontinued 2

Recommended Transition Protocol

Week 1: Stop Adderall and Start Strattera

• Discontinue Adderall immediately without tapering 1, 2
• Start atomoxetine at 40 mg daily 1
• Inform the patient that ADHD symptoms will return within hours to days after stopping the stimulant, but this is expected symptom recurrence, not withdrawal 1

Week 2-3: Titrate Strattera

• Increase atomoxetine to 60 mg daily after 7-14 days if tolerated 1
• Continue monitoring for ADHD symptom control 1

Week 3-4: Reach Target Dose

• Increase to 80 mg daily if needed for symptom control 1
• Maximum recommended dose is the lesser of 1.4 mg/kg/day or 100 mg/day 1

Critical Monitoring Points

Immediate Post-Transition (Days 1-7)

• Monitor for return of hyperactivity symptoms within hours to days, as stimulant effects wear off quickly 1
• Inattentive symptoms may take longer to fully manifest and require extended monitoring 1

Weeks 2-4

• Assess for therapeutic response to atomoxetine, which typically takes 2-4 weeks to reach full effect 1
• Monitor for atomoxetine side effects including decreased appetite, nausea, or mood changes 1

Ongoing Assessment

• Schedule follow-up every 2-4 weeks during the transition period to assess symptom control and medication tolerability 1
• Document baseline ADHD symptoms before discontinuing Adderall to compare with post-transition functioning 1

Common Pitfalls to Avoid

• Do not taper Adderall unnecessarily - this only prolongs the transition without clinical benefit since stimulants don't cause withdrawal 1, 2
• Do not start atomoxetine at full therapeutic dose - begin at 40 mg and titrate up to minimize side effects 1
• Do not mistake symptom recurrence for withdrawal - the return of ADHD symptoms after stopping Adderall is expected and represents the underlying condition, not a withdrawal syndrome 1
• Do not expect immediate therapeutic effect from atomoxetine - unlike stimulants which work within hours, atomoxetine requires 2-4 weeks to reach full efficacy 1

Special Considerations

If Symptoms Are Severe During Transition

• Consider a brief overlap period where low-dose Adderall is continued for 3-7 days while atomoxetine is initiated, then stop the stimulant once atomoxetine reaches 60-80 mg daily 1
• This approach is not medically necessary but may be preferred for patients who cannot tolerate any gap in symptom control 1

Patient Education

• Explain that the transition period of 2-4 weeks may involve suboptimal ADHD control while atomoxetine reaches therapeutic levels 1
• Reassure patients that the return of ADHD symptoms is temporary and expected, not a sign of treatment failure 1