Combining Atomoxetine and Sertraline

Introduction to Combination Therapy

The American Academy of Child and Adolescent Psychiatry guidelines note that caution should be exercised when combining two or more serotonergic drugs, but this is not an absolute contraindication, particularly for the combination of atomoxetine and sertraline 1, 2, 3, 4

When adding sertraline to established atomoxetine, consider reducing the atomoxetine dose by 25-50% and start sertraline at a low dose, then increase slowly, and monitor closely for 24-48 hours after each dose change, as recommended by the American Academy of Child and Adolescent Psychiatry 1, 2
The American Academy of Child and Adolescent Psychiatry suggests assessing for serotonin syndrome symptoms at each visit, particularly early in treatment, when combining atomoxetine and sertraline 1, 2, 3

In children and adolescents, the combination of atomoxetine and sertraline requires caution but is not prohibited, according to the American Academy of Child and Adolescent Psychiatry guidelines, and the same monitoring principles apply, with particular attention to behavioral activation or agitation 1, 2, 3, 4
The American Academy of Child and Adolescent Psychiatry recommends monitoring for suicidal ideation and growth parameters in children and adolescents taking the combination of atomoxetine and sertraline 3