How to Discontinue Strattera (Atomoxetine)
Atomoxetine can be discontinued abruptly without tapering, as stated in the FDA prescribing information. 1
Key Discontinuation Principle
- Atomoxetine capsules can be discontinued without being tapered, according to the FDA drug label 1
- This is fundamentally different from many other psychiatric medications that require gradual dose reduction 1
- Discontinuation of atomoxetine was well tolerated in clinical trials, with a low incidence of discontinuation-emergent adverse events 2
Clinical Evidence Supporting Abrupt Discontinuation
- Clinical studies demonstrated that atomoxetine discontinuation was not associated with symptom rebound 2
- The medication appeared well tolerated upon discontinuation in pediatric populations with ADHD 2
- Atomoxetine discontinuation does not carry the same withdrawal risks as medications like benzodiazepines or SSRIs 3
Monitoring After Discontinuation
While tapering is not required, monitoring for return of ADHD symptoms is essential:
- Hyperactivity symptoms may return within hours to days after stopping atomoxetine 3
- Inattentive symptoms may take longer to re-emerge, requiring extended monitoring periods 3
- Develop a specific monitoring plan before discontinuation to identify symptom recurrence 3
Special Considerations
When Discontinuing Multiple Medications
- If the patient is taking atomoxetine along with other psychiatric medications, review the history of previous symptoms and medication response before discontinuing 3
- For patients on multiple medications targeting the same disorder (ADHD), discontinue adjunctive or augmenting agents first before stopping the primary medication 3
- Collateral history from previous prescribers may be critical when determining which medication to discontinue first 3
Pregnancy Considerations
- Atomoxetine does not appear to be associated with major congenital malformations or significant adverse obstetrical outcomes, though data are limited 3
- A recent large, well-controlled study showed no increased risks for long-term neurodevelopmental outcomes with atomoxetine use during pregnancy 3
Common Pitfall to Avoid
Do not confuse atomoxetine discontinuation with antidepressant or benzodiazepine discontinuation protocols. Unlike SSRIs (which require gradual tapering to avoid withdrawal symptoms like dizziness, nausea, and sensory disturbances) 4, atomoxetine does not require tapering 1. Applying unnecessary tapering protocols may prolong treatment unnecessarily and confuse patients about the medication's properties.
Practical Implementation
- Simply stop the medication at the current dose without dose reduction 1
- Inform the patient and family that no gradual reduction is needed 1
- Schedule follow-up within 1-2 weeks to assess for return of ADHD symptoms 3
- Ensure the patient understands the difference between symptom recurrence (which may occur) and withdrawal symptoms (which are not expected) 2