effects and toxicity.maprotilineMonitor Closely (1)atomoxetine and maprotiline both increase QTc interval. Use Caution/Monitor.maravirocMonitor Closely (1)maraviroc will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.mefloquineMonitor Closely (1)atomoxetine and mefloquine both increase QTc interval. Use Caution/Monitor.metaproterenolMonitor Closely (1)metaproterenol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .methadoneSerious - Use Alternative (1)atomoxetine and methadone both increase QTc interval. Avoid or Use Alternate Drug.methylphenidateMonitor Closely (1)methylphenidate will increase the level or effect of atomoxetine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.midodrineMonitor Closely (1)atomoxetine, midodrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as midodrine.midostaurinSerious - Use Alternative (1)atomoxetine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.mifepristoneMonitor Closely (1)atomoxetine and mifepristone both increase QTc interval. Use Caution/Monitor.mirabegronMonitor Closely (1)mirabegron will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.mirtazapineMonitor Closely (1)atomoxetine and mirtazapine both decrease QTc interval. Use Caution/Monitor.nilotinibMonitor Closely (1)nilotinib will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)atomoxetine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.norepinephrineMonitor Closely (1)atomoxetine, norepinephrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as norepinephrine.nortriptylineMonitor Closely (1)atomoxetine and nortriptyline both increase QTc interval. Use Caution/Monitor.octreotideMonitor Closely (1)atomoxetine and octreotide both increase QTc interval. Use Caution/Monitor.ofloxacinMonitor Closely (1)atomoxetine and ofloxacin both increase QTc interval. Use Caution/Monitor.olanzapineMonitor Closely (1)atomoxetine and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesolodaterol inhaledMonitor Closely (1)atomoxetine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor.ondansetronSerious - Use Alternative (1)atomoxetine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.osilodrostatMonitor Closely (1)osilodrostat and atomoxetine both increase QTc interval. Use Caution/Monitor.osimertinibSerious - Use Alternative (1)atomoxetine and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.oxaliplatinSerious - Use Alternative (1)atomoxetine and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.ozanimodSerious - Use Alternative (1)atomoxetine and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.paliperidoneSerious - Use Alternative (1)atomoxetine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.panobinostatMonitor Closely (1)panobinostat will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Panobinostat can increase the levels and effects of sensitive CYP2D6 substrates or those with a narrow therapeutic index CYP2D6.Serious - Use Alternative (1)atomoxetine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug.paroxetineMonitor Closely (1)paroxetine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Reduced initial doses of atomoxetine are recommended with strong CYP2D6 inhibitors.pasireotideMonitor Closely (1)atomoxetine and pasireotide both increase QTc interval. Use Caution/Monitor.pazopanibSerious - Use Alternative (1)atomoxetine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.peginterferon alfa 2bMonitor Closely (1)peginterferon alfa 2b, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.pentamidineSerious - Use Alternative (1)atomoxetine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.perphenazineMonitor Closely (2)atomoxetine and perphenazine both increase QTc interval. Use Caution/Monitor. perphenazine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.phenelzineContraindicated (1)phenelzine increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.phenylephrineMonitor Closely (1)atomoxetine, phenylephrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as phenylephrine.pimavanserinSerious - Use Alternative (1)atomoxetine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.pimozideSerious - Use Alternative (1)atomoxetine and pimozide both increase QTc interval. Contraindicated.pirbuterolMonitor Closely (1)pirbuterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .pitolisantSerious - Use Alternative (1)atomoxetine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.ponesimodSerious - Use Alternative (1)atomoxetine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.posaconazoleMonitor Closely (1)atomoxetine and posaconazole both increase QTc interval. Use Caution/Monitor.primaquineMonitor Closely (1)atomoxetine and primaquine both increase QTc interval. Use Caution/Monitor.procainamideSerious - Use Alternative (1)atomoxetine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.procarbazineContraindicated (1)procarbazine increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.propafenoneMonitor Closely (1)propafenone will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)atomoxetine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.protriptylineMonitor Closely (1)atomoxetine and protriptyline both increase QTc interval. Use Caution/Monitor.quetiapineSerious - Use Alternative (1)atomoxetine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.quinidineMonitor Closely (1)quinidine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Reduced initial doses of atomoxetine are recommended with strong CYP2D6 inhibitors.Serious - Use Alternative (1)atomoxetine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.quinineSerious - Use Alternative (1)atomoxetine and quinine both increase QTc interval. Avoid or Use Alternate Drug.ranolazineMonitor Closely (2)ranolazine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. atomoxetine and ranolazine both increase QTc interval. Use Caution/Monitor.rasagilineContraindicated (1)rasagiline increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.ribociclibSerious - Use Alternative (1)atomoxetine and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.rilpivirineMonitor Closely (1)atomoxetine and rilpivirine both increase QTc interval. Use Caution/Monitor.risperidoneMonitor Closely (1)atomoxetine and risperidone both increase QTc interval. Use Caution/Monitor.ritonavirMonitor Closely (1)ritonavir will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.rolapitantMonitor Closely (1)rolapitant will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.romidepsinMonitor Closely (1)atomoxetine and romidepsin both increase QTc interval. Use Caution/Monitor.salmeterolMonitor Closely (1)salmeterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .saquinavirSerious - Use Alternative (1)atomoxetine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.selegilineContraindicated (1)selegiline increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.selegiline transdermalContraindicated (1)selegiline transdermal increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.selpercatinibSerious - Use Alternative (1)atomoxetine and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.sertralineMonitor Closely (2)atomoxetine and sertraline both increase QTc interval. Use Caution/Monitor. sertraline will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.sevofluraneSerious - Use Alternative (1)atomoxetine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.siponimodSerious - Use Alternative (1)atomoxetine and siponimod both increase QTc interval. Avoid or Use Alternate Drug.solifenacinMonitor Closely (1)atomoxetine and solifenacin both increase QTc interval. Use Caution/Monitor.sorafenibSerious - Use Alternative (1)atomoxetine and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.sotalolSerious - Use Alternative (1)atomoxetine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.sunitinibMonitor Closely (1)atomoxetine and sunitinib both increase QTc interval. Use Caution/Monitor.tacrolimusMonitor Closely (1)atomoxetine and tacrolimus both increase QTc interval. Use Caution/Monitor.telavancinMonitor Closely (1)atomoxetine and telavancin both increase QTc interval. Use Caution/Monitor.terbinafineMonitor Closely (1)terbinafine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalineMonitor Closely (1)terbutaline, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .tetrabenazineSerious - Use Alternative (1)atomoxetine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.thioridazineContraindicated (1)atomoxetine and thioridazine both increase QTc interval. Contraindicated.Monitor Closely (1)thioridazine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tipranavirMonitor Closely (1)tipranavir will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.toremifeneSerious - Use Alternative (1)atomoxetine and toremifene both increase QTc interval. Avoid or Use Alternate Drug.tranylcypromineContraindicated (1)tranylcypromine increases effects of atomoxetine by pharmacodynamic synergism. Contraindicated. The use of atomoxetine with monoamine oxidase inhibitors (MAOIs) is contraindicated. Risk of acute hypertensive episode.trazodoneSerious - Use Alternative (1)atomoxetine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.triclabendazoleMonitor Closely (1)atomoxetine and triclabendazole both increase QTc interval. Use Caution/Monitor.trimipramineMonitor Closely (1)atomoxetine and trimipramine both increase QTc interval. Use Caution/Monitor.triptorelinMonitor Closely (1)atomoxetine and triptorelin both increase QTc interval. Use Caution/Monitor.valbenazineMonitor Closely (1)valbenazine and atomoxetine both increase QTc interval. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)atomoxetine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.vardenafilMonitor Closely (1)atomoxetine and vardenafil both increase QTc interval. Use Caution/Monitor.vemurafenibSerious - Use Alternative (1)atomoxetine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.venlafaxineMonitor Closely (1)venlafaxine will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.vilanterol/fluticasone furoate inhaledMonitor Closely (1)atomoxetine and vilanterol/fluticasone furoate inhaled both increase QTc interval. Use Caution/Monitor.voclosporinMonitor Closely (1)atomoxetine and voclosporin both increase QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)atomoxetine and voriconazole both increase QTc interval. Use Caution/Monitor.vorinostatMonitor Closely (1)atomoxetine and vorinostat both increase QTc interval. Use Caution/Monitor.ziprasidoneSerious - Use Alternative (1)atomoxetine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. >10% Children and adolescents Headache (19%) Abdominal pain (17-18%) Decreased appetite (16%) Vomiting (11%) Somnolence (11%) Adults Nausea (26%) Dry mouth (20%) Decreased appetite (16%) Insomnia (15%) 1-10% Children and adolescents Nausea (7-13%) Fatigue (6-8%) Irritability (6%) Dizziness (5%) Weight decreased (3%) Anorexia (3%) Therapeutic response unexpected (2%) Rash (2%) Constipation (1-2%) Mood swings (1-2%) Adults Fatigue (10%) Constipation (8%) Dizziness (8%) Somnolence (8%) Erectile dysfunction (8%) Abdominal pain (7%) Urinary hesitation (6%) Irritability (5%) Dyspepsia (4%) Vomiting (4%) Abnormal dreams (4%) Ejaculation delayed and/or ejaculation disorder (4%) Hyperhidrosis (4%) Libido decreased (3%) Sleep disorder (3%) Chills (3%) Palpitations (3%) Paresthesia (3%) Dysmenorrhea (3%) Hot flush (3%) Feeling jittery (2%) Thirst (2%) Weight decreased (2%) Dysuria (2%) Postmarketing Reports Cardiovascular system: QT prolongation, syncope Peripheral vascular effects: Raynaud phenomenon General disorders and administration site conditions: Lethargy Musculoskeletal system: Rhabdomyolysis Nervous system disorders: Hypoaesthesia; paresthesia in children and adolescents; sensory disturbances; tics Psychiatric disorders: Depression and depressed mood; anxiety, libido changes Seizures: Seizures Skin and subcutaneous tissue disorders: Alopecia, hyperhidrosis Urogenital system: Male pelvic pain; urinary hesitation and retention Black Box Warnings Atomoxetine use has been associated with increased risk of suicidal ideation in short-term studies in children or adolescents with ADHD; this risk must be balanced against clinical need in patients with ADHD Monitor patients closely for suicidal thinking and behavior, clinical worsening, or unusual behavioral changes; families and caregivers should be advised of need for close observation and communication with prescribing healthcare provider Average risk of suicidal ideation in patients receiving atomoxetine has been shown to be ~0.4% (5/1357 patients)Contraindications Hypersensitivity Narrow-angle glaucoma Administration concomitantly with or within 14 days of monoamine oxidase inhibitor (MAOI) therapy; risk of potentially fatal reaction, including hyperthermia, myoclonus, altered mental status, and neuroleptic malignant syndrome (NMS)-like symptoms Pheochromocytoma: Serious reactions, including elevated blood pressure and tachyarrhythmia, have been reported in patients with current or previous pheochromocytoma Severe cardiovascular disorders where condition would deteriorate because BP increases by 15-20 mm Hg or HR increases by 20 beats/min; risk is greater in poor CYP2D6 metabolizers Cautions Liver injury reported within 120 days of initiation of atomoxetine; patients may present with elevated liver enzymes (>20x ULN) and jaundice with significantly elevated bilirubin levels (>2x ULN), followed by recovery upon discontinuance of atomoxetine Orthostatic hypotension and syncope reported Risk of suicidal thoughts in children and adolescents Small risk of allergic reaction Use caution in hypertension, tachycardia (see Contraindications) Sudden deaths, stroke, and myocardial infarction reported in patients with structural cardiac abnormalities or other serious heart problems taking stimulants