Safety of Using Strattera (Atomoxetine) and Sertraline Together

Potential Risks and Interactions

The American Academy of Child and Adolescent Psychiatry suggests that sertraline, a selective serotonin reuptake inhibitor (SSRI), can increase serotonin levels, while atomoxetine, a selective norepinephrine reuptake inhibitor, primarily affects norepinephrine but may have some minor serotonergic effects 1, 2
Combining two or more serotonergic drugs, including SSRIs like sertraline, requires caution due to the risk of serotonin syndrome, which can develop within 24-48 hours after combining medications 1, 3
Symptoms of serotonin syndrome include mental status changes, such as confusion, agitation, and anxiety, as well as neuromuscular hyperactivity and autonomic hyperactivity 1, 4

The combination of atomoxetine and sertraline may interact due to sertraline's effect on drugs metabolized by CYP2D6, which could lead to increased atomoxetine levels 2, 5

If the combination is clinically necessary, the American Academy of Child and Adolescent Psychiatry recommends starting the second medication at a low dose and increasing it slowly, while monitoring closely for symptoms of serotonin syndrome 1, 3, 5
Patients should be monitored for mental status changes, neuromuscular symptoms, and autonomic nervous system function, especially in the first 24-48 hours after dosage changes 1, 3, 4
The combination should be avoided in patients with a history of seizures, as both medications can lower the seizure threshold 1

The American Academy of Child and Adolescent Psychiatry advises against combining either medication with monoamine oxidase inhibitors (MAOIs), as this significantly increases the risk of serotonin syndrome 1
Patients should be monitored for potential discontinuation syndrome if sertraline is stopped abruptly, and both medications can cause initial anxiety or agitation, which may be misinterpreted as worsening of the underlying condition rather than a medication side effect 1, 4, 5