What is the recommended tapering schedule for a patient taking atomoxetine (Strattera)?

Atomoxetine Does Not Require Tapering

Atomoxetine can be discontinued abruptly without tapering, as it does not cause rebound symptoms or discontinuation syndrome. 1, 2

FDA-Approved Discontinuation Protocol

• The FDA label explicitly states: "Atomoxetine capsules can be discontinued without being tapered" 1
• Patients may miss occasional doses without experiencing rebound effects or discontinuation syndrome 3
• No gradual dose reduction is necessary when stopping atomoxetine 2

Evidence Supporting Abrupt Discontinuation

Prospective, placebo-controlled studies in both children and adults demonstrated that abrupt discontinuation of atomoxetine after 9-10 weeks of continuous therapy did not produce a discontinuation syndrome. 2

Key findings from discontinuation studies:

• The incidence of discontinuation-emergent adverse events was low and not statistically different from placebo 2
• ADHD symptoms worsened following discontinuation but did not return to pretreatment levels (no rebound effect) 2
• Atomoxetine discontinuation was well tolerated without acute withdrawal symptoms 2

Mechanism Explaining Safe Discontinuation

Unlike medications affecting serotonin or dopamine systems that cause neuroadaptations requiring gradual tapering, atomoxetine's selective norepinephrine reuptake inhibition does not produce the same physiological dependence 2, 3. This distinguishes it from:

• Serotonin reuptake inhibitors (which require tapering except fluoxetine) 4
• Stimulant medications (which can cause rebound) 3
• Antipsychotics (which may cause dopaminergic hypersensitivity) 5

Clinical Switching Scenarios

When switching from atomoxetine to another ADHD medication:

• Atomoxetine may be stopped immediately while initiating the new medication 3
• No cross-tapering period is required 3
• When switching to atomoxetine from stimulants, cross-tapering with co-administration is safe, but stopping the stimulant abruptly while starting atomoxetine is also acceptable 3

Important Caveats

Monitor for return of ADHD symptoms after discontinuation, which represents disease recurrence rather than withdrawal. 2

• Symptom worsening occurs gradually over days to weeks, not acutely 2
• This is expected disease recurrence, not a discontinuation syndrome requiring reinitiation 2
• If symptoms return and treatment resumption is needed, restart at the previously effective dose without titration 1