Can a Patient Use Strattera (Atomoxetine) with a Stimulant?
Yes, atomoxetine can be safely combined with stimulant medications for ADHD treatment, and this combination has been shown to be both safe and effective. 1
Evidence Supporting Combination Therapy
Atomoxetine has been systematically studied and demonstrated to be safe and effective when used in combination with stimulants. 1 This represents the highest quality evidence directly addressing your question from recent literature.
The combination strategy is particularly useful when monotherapy with either agent provides insufficient symptom control throughout the day or when targeting different symptom domains. 1
Clinical Scenarios Where Combination Therapy Is Appropriate
- Consider combining atomoxetine with a stimulant when:
- A patient has partial response to stimulant monotherapy but needs additional coverage, particularly for evening symptoms 2
- A patient requires extended symptom control beyond what a single stimulant dose provides 3
- A patient has comorbid anxiety or tics where atomoxetine may address these symptoms while the stimulant targets core ADHD symptoms 2, 4
Important Monitoring Parameters When Using Combination Therapy
Monitor cardiovascular parameters closely: Both medications can increase heart rate and blood pressure, so regular pulse and blood pressure assessments are essential 3, 2
Track for additive side effects: Watch for insomnia (more common with stimulants), decreased appetite (common with both), and mood changes 3, 2
Assess for irritability and mood lability, as these can occur with either medication class 3
Contraindications That Apply to Both Medications
Do not use this combination with MAO inhibitors - this is an absolute contraindication for stimulants and would create severe hypertensive risk 5
Avoid in patients with active psychosis - stimulants are contraindicated in schizophrenia and psychotic disorders 5
Exercise extreme caution in patients with active substance use disorders, though atomoxetine itself carries negligible abuse potential 6, 7, 1
Practical Considerations
Atomoxetine takes longer to reach full effect (median 3.7 weeks, with continued improvement up to 52 weeks), while stimulants work immediately 1. Start atomoxetine first and add the stimulant once atomoxetine is at therapeutic dose, or vice versa depending on urgency of symptom control.
The combination allows use of lower doses of each medication, potentially reducing side effects while maintaining efficacy 1
This combination does not require any special precautions beyond standard monitoring for each medication individually 1