Atomoxetine (Strattera)
What is atomoxetine?
Atomoxetine is known as Strattera in the United States and Japan alike. In Japan the Strattera brand itself is no longer supplied (the manufacturer stopped making it in 2024 and said its remaining stock would run out during 2025), so what you receive here is atomoxetine made by other companies, with アトモキセチン rather than ストラテラ on Japanese packaging; it is the same medicine, and supply has recovered. It's a non-stimulant medicine for ADHD: it works steadily through the day by raising noradrenaline, a brain messenger involved in attention and self-control.
How is it different from stimulant ADHD medicines?
- Not a controlled substance: no registration system; any doctor can prescribe it, and it travels across borders under ordinary medicine rules (up to a month's supply without paperwork)
- Smooth, around-the-clock coverage: no on-off cycle through the day
- Very low potential for misuse, and no dependence
- Fully startable for adults in Japan: no registry, unlike stimulant treatment
What is it used for in Japan?
ADHD (attention-deficit / hyperactivity disorder), in both children and adults.
How does it help?
By steadily raising noradrenaline, it supports focus, impulse control, and settling restlessness. Unlike stimulants, it is started low and raised step by step over several weeks: the benefit builds gradually rather than arriving on day one, so keep taking it as prescribed even if you don't notice a change at first.
Atomoxetine, guanfacine, or Concerta: which is right for me?
There's no universal winner; the three trade different strengths, and the choice is individual.
| Concerta (stimulant) | Atomoxetine (non-stimulant) | Guanfacine (non-stimulant) | |
|---|---|---|---|
| Speed | Works from day one | Builds over a few weeks | Builds over one to a few weeks |
| Effect | Often somewhat stronger on average, most clearly in children | Solid and steady, focus-led | Solid, especially on impulsivity and restlessness |
| Coverage | About 12 hours; can fade in the evening | Around the clock | Around the clock |
| Rules | Controlled medicine: registered doctors, pharmacies, and patients only | Ordinary medicine: any doctor, normal import rules | Ordinary medicine: any doctor, normal import rules |
| Habit-forming potential | Can be misused, so it is tightly controlled | None | None |
| Getting it right now | Shipments restricted since September 2025 and still restricted in October 2026; ask your clinic | Strattera brand no longer made; atomoxetine from other makers is available | Normally available |
Non-stimulants fit when misuse of a stimulant is a concern, or when the registration system for stimulants is a poor fit. Plenty of people do well on any of the three, switching is routine, and it's a decision you make with your doctor.
What should I tell my doctor before starting?
A few situations rule it out entirely; your doctor will choose something else if any of these apply:
- A past allergic reaction to atomoxetine
- Taking, or recently stopping, an MAO inhibitor; these can't overlap
- A serious heart or blood-vessel condition
- A phaeochromocytoma or paraganglioma (rare adrenal-area tumours), now or in the past
- Narrow-angle glaucoma
And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:
- High blood pressure, a fast heartbeat, or other heart concerns
- Long QT or another heart rhythm problem, or a family history of long QT, sudden cardiac death, or serious heart disease (a heart tracing may be done first)
- A past stroke, or fainting from low blood pressure on standing
- Bipolar disorder or a psychotic illness, now or in the past
- The antidepressant paroxetine, or other medicines that slow atomoxetine's breakdown; the dose is then built up more slowly
- Other medicines that act on noradrenaline, such as methylphenidate (Concerta) or some antidepressants
- Liver or kidney problems
- Difficulty passing urine (for example, with prostate enlargement)
- A history of seizures
- Pregnant, planning to be, or breastfeeding (see the section below)
Your blood pressure and pulse are checked before starting and during treatment, as atomoxetine can raise them, usually modestly. In children, height and weight are also followed.
How do I take it, and what if I miss a dose?
Atomoxetine is taken once or twice a day as your doctor directs, starting low and building up over weeks.
- If you miss a dose: take it when you remember that day, or just skip it if it's near the next one. Never take a double dose to catch up
- Early weeks: nausea is most likely then, and it usually fades; tell your doctor if it bothers you
- Give it its build-up time: judge the effect after several weeks rather than after a few days
What side effects should I expect?
Most are mild and often settle, and many can be eased with a counter-medicine (nausea, for example). Not everyone gets them.
- Nausea (around 30%): the most common one, and mostly an early-weeks experience; it usually fades as your body adjusts, and a counter-medicine can help in the meantime
- Reduced appetite (around 20%): mostly an early-treatment effect; keeping regular mealtimes helps, and it usually settles
- Drowsiness (around 15%)
- Headache (around 15%)
- Dry mouth
- Some weight loss
- A faster heartbeat, or a small rise in blood pressure
If anything is bothering you, tell your doctor; there's often a way to adjust.
Finally, two things that are rare (most people never experience them) but good to know:
- Yellowing of the skin or eyes, dark urine, or unusual tiredness: very rare, but worth a prompt check, as these can point to the liver
- Mood changes early in treatment, especially in younger people: if mood dips or distressing thoughts appear, tell your doctor straight away so the plan can be adjusted
Will I become dependent? How do I stop safely?
No; atomoxetine isn't a stimulant and isn't habit-forming. There's no craving, and stopping doesn't cause a withdrawal syndrome, so it can usually be stopped without a long taper. Even so, time any change with your doctor rather than deciding alone, so that the benefit isn't lost.
Can I drive while taking it?
The Japanese label advises against driving while taking it. Drowsiness and dizziness can occur, and the prescribing information here instructs that patients on atomoxetine shouldn't drive or operate dangerous machinery. In practice, discuss your own situation with your doctor, especially in the first weeks and after dose changes.
What about pregnancy and breastfeeding?
Tell your doctor early; this is decided case by case. There's less accumulated data than with older medicines, so the plan is individual: weighing how much the treatment is doing for you against the unknowns. Don't stop or continue on your own. Our guides to medication in pregnancy and medication while breastfeeding cover the wider picture.