Switching from Strattera to a Stimulant
You can stop Strattera (atomoxetine) abruptly and start a stimulant immediately without tapering. 1
Direct Transition Protocol
- Atomoxetine can be discontinued without tapering, as stated explicitly in the FDA label: "Atomoxetine capsules can be discontinued without being tapered." 1
- No withdrawal syndrome occurs with abrupt atomoxetine discontinuation, as demonstrated in prospective placebo-controlled studies showing no statistically significant differences in discontinuation-emergent adverse events between patients stopping atomoxetine versus those on placebo. 2
- No adjuvant medications are needed for withdrawal management (unlike opioids which require clonidine), and there is no seizure risk from abrupt cessation (unlike benzodiazepines or barbiturates). 3
Starting the Stimulant
- Begin the stimulant on the same day you stop atomoxetine or the next day, as there are no pharmacological interactions requiring a washout period. 4, 5
- Standard stimulant titration applies: Start at the lowest dose and increase weekly based on response and tolerability. 6
- Monitor cardiovascular parameters (heart rate and blood pressure) at baseline and during titration, as both medication classes can increase these parameters. 4, 5
What to Expect After Stopping Atomoxetine
- ADHD symptoms will worsen after discontinuation but typically do not return to pretreatment baseline levels immediately. 2
- No rebound phenomenon occurs, unlike some other psychiatric medications that require tapering. 7, 2
- The stimulant will provide symptom coverage more rapidly than atomoxetine did initially, as stimulants work within hours while atomoxetine requires weeks to reach full effect. 8
Important Monitoring Considerations
- Screen for contraindications to stimulants before initiating, including active psychosis, severe cardiovascular disease, hyperthyroidism, glaucoma, and concurrent MAO inhibitor use. 6, 4
- Assess for substance abuse risk in adolescents and adults, as stimulants have abuse potential while atomoxetine does not. 6, 9
- Watch for mood destabilization in the first 24-48 hours after starting the stimulant, particularly in patients with family history of bipolar disorder. 5
Clinical Pitfalls to Avoid
- Don't assume tapering is needed simply because atomoxetine is a psychiatric medication—the evidence clearly shows it can be stopped abruptly. 1, 2
- Don't delay starting the stimulant waiting for atomoxetine to "clear"—there is no pharmacological reason for a washout period. 4, 5
- Don't restart atomoxetine if symptoms worsen in the first few days after stopping—this represents expected symptom recurrence that the new stimulant will address once titrated to an effective dose. 2