Is Strattera (Atomoxetine) allowed for Department of Transportation (DOT) purposes?

From the Guidelines

Strattera (atomoxetine) is generally allowed for commercial drivers under Department of Transportation (DOT) regulations. Unlike stimulant medications used for ADHD such as Adderall or Ritalin, Strattera is not a controlled substance and does not cause the same concerns about alertness impairment or potential for abuse 1. Commercial drivers with ADHD who need medication can typically use Strattera while maintaining their commercial driver's license (CDL). However, the driver should work closely with their healthcare provider to ensure proper dosing and monitoring for side effects. During the initial adjustment period to Strattera, some individuals may experience drowsiness or dizziness, so it's advisable to understand how the medication affects you before operating commercial vehicles. The medical examiner performing the DOT physical should be informed about all medications being taken, including Strattera, to make an appropriate fitness determination. Strattera works differently than stimulants by selectively inhibiting norepinephrine reuptake, which helps improve attention and reduce impulsivity without the central nervous system stimulant effects that concern DOT regulators.

Some key points to consider when using Strattera for commercial drivers with ADHD include:

• Monitoring for signs of misuse or diversion of ADHD medication, as noted in the 2011 clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents 1
• Providing medication coverage for symptom control while driving, with longer-acting or late-afternoon, short-acting medications potentially being helpful in this regard 1
• Ensuring proper dosing and monitoring for side effects, as well as informing the medical examiner performing the DOT physical about all medications being taken, including Strattera

It's worth noting that the 2024 study on attention-deficit/hyperactivity disorder in pregnancy and the postpartum period highlights the importance of treatment in improving driving capability, particularly in individuals with severe or untreated ADHD 1. However, this study does not directly address the use of Strattera in commercial drivers, and the 2011 guideline remains the most relevant evidence for this specific question.

From the Research

Strattera and DOT

• Strattera, also known as atomoxetine, is a selective norepinephrine reuptake inhibitor used to treat attention-deficit hyperactivity disorder (ADHD) in children, adolescents, and adults 2, 3, 4.
• The US Food and Drug Administration approved atomoxetine for the treatment of ADHD in 2002, and it is considered a non-stimulant option for patients who are at risk for substance abuse or do not wish to take a controlled substance 3, 4.
• Atomoxetine is not classified as a stimulant and is not a controlled substance in the US, which makes it a valuable option for patients who require treatment for ADHD but may be at risk for substance abuse 2, 3.
• The medication has been shown to be effective in improving ADHD symptoms, quality of life, and emotional lability, with a median time to response of 3.7 weeks 4.
• Atomoxetine can be administered once or twice daily, and its dosage regimen can be adjusted based on the patient's response to treatment and their CYP2D6 genotype 5.

Safety and Efficacy

• Atomoxetine has been found to be generally well tolerated, with common adverse events including headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 2, 3.
• The medication has a negligible risk of abuse or misuse, and its subjective-effects profile is different from that of methylphenidate 3.
• Atomoxetine has been shown to be safe and effective in combination with stimulants, and it has been studied systematically in subjects with ADHD and comorbid oppositional defiant disorder, anxiety, depression, and substance use disorders 4.
• However, atomoxetine should not be given to patients with known cardiovascular problems, and all adult patients who receive atomoxetine should be monitored for changes in blood pressure throughout treatment 6.

DOT Regulations

• There is no direct evidence in the provided studies regarding the use of Strattera in relation to Department of Transportation (DOT) regulations.
• However, given that atomoxetine is not a controlled substance and has a negligible risk of abuse or misuse, it is likely that it would be allowed for use by individuals subject to DOT regulations, but this would depend on the specific regulations and guidelines in place.