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Atomoxetine side effects: what 23,660 FDA adverse event reports show

Atomoxetine Hydrochloride · 1,126 reaction terms · 128,842 drug–reaction co-reports · data 2026-09-14
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Drug class

Selective norepinephrine reuptake inhibitor

FDA label, Indications wording

Who reports

23,660 reports · 39% serious · 1,472 with death outcome · 42% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Atomoxetine capsule is a selective norepinephrine reuptake inhibitor indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). ( 1.1 ) 1.1 Attention-Deficit/Hyperactivity Disorder (ADHD) Atomoxetine capsule is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD).

FDA label, Indications and Usage

What it is

Atomoxetine, USP is a selective norepinephrine reuptake inhibitor. Atomoxetine hydrochoride is the R (-) isomer as determined by x-ray diffraction. The chemical designation is (-)- N -Methyl-3-phenyl-3-( o -tolyloxy)-propylamine hydrochloride.

FDA label, Description section

Boxed warning

SUICIDAL IDEATION IN CHILDREN AND ADOLESCENTS Atomoxetine increased the risk of suicidal ideation in short-term studies in children or adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Anyone considering the use of atomoxetine in a child or adolescent must balance this risk with the clinical need.

FDA label
How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled adverse reaction 3Labeled (related wording) 5Likely indication confounding 5Lab value / disease marker 4Not in label — unassessed 23
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 1,086 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Hepatic enzyme66800.8
573.5–1,118.0ROR 803.0 · χ² 27,089 / p <1e-300
372.9 EB05 303.3 · IC025 +6.3
3/3 methods agree
Labeled adverse reaction
exact term
serious n=66 · ♀ 100% (drug 42%) · 100% cliniciannot reported in cached trials
Semenuria28789.0
473.4–1,315.0ROR 789.9 · χ² 11,168 / p <1e-300
323.3 EB05 234.7 · IC025 +5.0
3/3 methods agree
Not in label — unassessed♀ 0% (drug 42%) · 100% consumernot reported in cached trials
Growth hormone-producing pituitary tumour14679.4
338.0–1,365.9ROR 679.8 · χ² 4,960 / p <1e-300
251.5 EB05 159.2 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=14not reported in cached trials
Fight in school16241.0
138.6–419.1ROR 241.1 · χ² 2,812 / p <1e-300
154.6 EB05 100.9 · IC025 +4.0
3/3 methods agree
Not in label — unassessed–not reported in cached trials
Excitability56226.5
168.8–303.8ROR 227.0 · χ² 9,804 / p <1e-300
169.7 EB05 135.6 · IC025 +5.7
3/3 methods agree
Not in label — unassessed–not reported in cached trials
Facet joint syndrome503168.4
153.2–185.1ROR 172.1 · χ² 70,050 / p <1e-300
140.6 EB05 130.6 · IC025 +6.8
3/3 methods agree
Not in label — unassessedserious n=503 · ♀ 100% (drug 42%) · 96% cliniciannot reported in cached trials
Hypocholesterolaemia46155.7
113.8–213.1ROR 156.1 · χ² 5,872 / p <1e-300
125.5 EB05 97.9 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=46 · ♀ 100% (drug 42%) · 100% cliniciannot reported in cached trials
Early morning awakening17135.0
81.0–225.0ROR 135.1 · χ² 1,844 / p <1e-300
103.7 EB05 68.6 · IC025 +3.9
3/3 methods agree
Labeled adverse reaction
exact term
–not reported in cached trials
Oppositional defiant disorder49124.1
92.0–167.3ROR 124.3 · χ² 5,131 / p <1e-300
104.4 EB05 82.1 · IC025 +5.2
3/3 methods agree
Not in label — unassessedserious n=32 · ♀ 15% (drug 42%)NCT00190684: 1/1,551 (0.1%) on Atomoxetine (serious AE)
Gilbert's syndrome10119.7
61.8–231.7ROR 119.7 · χ² 933 / p 3e-205
88.2 EB05 51.2 · IC025 +3.1
3/3 methods agree
Not in label — unassessedserious n=8not reported in cached trials
Overlap syndrome78113.0
89.3–143.0ROR 113.4 · χ² 7,568 / p <1e-300
97.8 EB05 80.9 · IC025 +5.6
3/3 methods agree
Not in label — unassessedserious n=78 · ♀ 100% (drug 42%) · 100% cliniciannot reported in cached trials
Blepharospasm58992.9
85.5–101.1ROR 95.3 · χ² 48,350 / p <1e-300
83.9 EB05 78.3 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=552 · ♀ 95% (drug 42%)not reported in cached trials
Penile discharge2483.2
54.7–126.4ROR 83.3 · χ² 1,705 / p <1e-300
71.9 EB05 50.8 · IC025 +4.2
3/3 methods agree
Not in label — unassessed♀ 0% (drug 42%)not reported in cached trials
Swollen joint count2182.6
52.8–129.2ROR 82.7 · χ² 1,473 / p <1e-300
70.9 EB05 48.9 · IC025 +4.1
3/3 methods agree
Not in label — unassessedserious n=21 · ♀ 100% (drug 42%) · 100% cliniciannot reported in cached trials
Onychomadesis34379.7
71.4–89.0ROR 80.9 · χ² 24,368 / p <1e-300
72.9 EB05 66.6 · IC025 +5.9
3/3 methods agree
Not in label — unassessedserious n=343 · ♀ 100% (drug 42%) · 95% cliniciannot reported in cached trials
School refusal1477.9
45.1–134.5ROR 77.9 · χ² 906 / p 2e-199
65.5 EB05 41.5 · IC025 +3.5
3/3 methods agree
Not in label — unassessedserious n=8not reported in cached trials
Rheumatic fever34676.2
68.3–85.0ROR 77.3 · χ² 23,556 / p <1e-300
69.9 EB05 63.9 · IC025 +5.8
3/3 methods agree
Not in label — unassessedserious n=346 · ♀ 100% (drug 42%) · 93% cliniciannot reported in cached trials
Attention-seeking behaviour1272.8
40.4–131.2ROR 72.8 · χ² 719 / p 9e-159
61.1 EB05 37.2 · IC025 +3.2
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=6not reported in cached trials
Breast cancer stage iii47170.0
63.8–76.8ROR 71.4 · χ² 29,592 / p <1e-300
64.7 EB05 59.9 · IC025 +5.8
3/3 methods agree
Not in label — unassessedserious n=471 · ♀ 100% (drug 42%) · 96% cliniciannot reported in cached trials
Tic38667.4
60.8–74.7ROR 68.5 · χ² 23,376 / p <1e-300
62.4 EB05 57.4 · IC025 +5.7
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=83 · ♀ 18% (drug 42%)not reported in cached trials
Urinary hesitation16264.1
54.7–75.2ROR 64.6 · χ² 9,324 / p <1e-300
59.4 EB05 52.1 · IC025 +5.4
3/3 methods agree
Labeled adverse reaction
exact term
serious n=16 · ♀ 14% (drug 42%)NCT00700427: 1/180 (0.6%) on Atomoxetine
Duodenal ulcer perforation48662.8
57.3–68.8ROR 64.1 · χ² 27,527 / p <1e-300
58.5 EB05 54.3 · IC025 +5.6
3/3 methods agree
Not in label — unassessedserious PRR 85.8 · ♀ 100% (drug 42%) · 95% cliniciannot reported in cached trials
Onychomycosis27459.1
52.3–66.8ROR 59.8 · χ² 14,610 / p <1e-300
55.2 EB05 50.0 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=274 · ♀ 100% (drug 42%) · 93% cliniciannot reported in cached trials
Adulterated product1258.9
32.8–105.6ROR 58.9 · χ² 587 / p 7e-130
51.0 EB05 31.1 · IC025 +3.1
3/3 methods agree
Not in label — unassessedserious n=12not reported in cached trials
Lupus vulgaris7357.9
45.7–73.3ROR 58.0 · χ² 3,773 / p <1e-300
53.6 EB05 44.1 · IC025 +4.9
3/3 methods agree
Not in label — unassessedserious n=73 · ♀ 100% (drug 42%) · 95% cliniciannot reported in cached trials
Subcutaneous drug absorption impaired3357.1
40.1–81.2ROR 57.2 · χ² 1,655 / p <1e-300
52.1 EB05 38.8 · IC025 +4.3
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=33 · ♀ 100% (drug 42%)not reported in cached trials
Deep vein thrombosis postoperative11856.7
47.1–68.3ROR 57.0 · χ² 6,011 / p <1e-300
52.9 EB05 45.3 · IC025 +5.1
3/3 methods agree
Not in label — unassessedserious n=118 · ♀ 100% (drug 42%)not reported in cached trials
Prescribed overdose1,12954.9
51.7–58.2ROR 57.6 · χ² 56,195 / p <1e-300
51.7 EB05 49.2 · IC025 +5.6
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious PRR 26.6not reported in cached trials
Educational problem9754.4
44.3–66.7ROR 54.6 · χ² 4,733 / p <1e-300
50.7 EB05 42.8 · IC025 +5.0
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=21not reported in cached trials
Negativism4353.0
39.0–72.1ROR 53.1 · χ² 2,019 / p <1e-300
49.0 EB05 37.9 · IC025 +4.5
3/3 methods agree
Not in label — unassessedserious n=12 · ♀ 14% (drug 42%)NCT00190684: 1/1,551 (0.1%) on Atomoxetine (serious AE)
C-reactive protein5152.7
39.8–69.9ROR 52.8 · χ² 2,392 / p <1e-300
48.9 EB05 38.7 · IC025 +4.6
3/3 methods agree
Lab value / disease markerserious n=51 · ♀ 100% (drug 42%) · 100% cliniciannot reported in cached trials
Anti-cyclic citrullinated peptide antibody positive37849.8
44.9–55.1ROR 50.5 · χ² 17,044 / p <1e-300
47.0 EB05 43.2 · IC025 +5.3
3/3 methods agree
Lab value / disease markerserious PRR 69.2 · ♀ 100% (drug 42%) · 96% cliniciannot reported in cached trials
Urine amphetamine positive1747.8
29.3–77.8ROR 47.8 · χ² 694 / p 3e-153
43.3 EB05 28.6 · IC025 +3.5
3/3 methods agree
Lab value / disease marker–not reported in cached trials
Lip dry45247.1
42.8–51.7ROR 47.9 · χ² 19,296 / p <1e-300
44.6 EB05 41.3 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=444 · ♀ 98% (drug 42%) · 95% cliniciannot reported in cached trials
X-ray abnormal9047.0
38.0–58.1ROR 47.2 · χ² 3,803 / p <1e-300
44.3 EB05 37.1 · IC025 +4.8
3/3 methods agree
Lab value / disease markerserious n=90 · ♀ 100% (drug 42%) · 100% cliniciannot reported in cached trials

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Atomoxetine as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (4 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Drug ineffective (drug did not work)2,4061.6
1.6–1.7ROR 1.7 · χ² 608 / p 1e-134
1.6 EB05 1.6 · IC025 +0.6Reporting / coding artifactserious PRR 2.6not reported in cached trials
Fatigue (tiredness)1,8822.1
2.1–2.2ROR 2.2 · χ² 1,198 / p 9e-263
2.1 EB05 2.1 · IC025 +1.0
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 2.5NCT00700427: 4/180 (2.2%) on Atomoxetine; 3/258 (1.2%) control
Nausea1,8732.1
2.0–2.2ROR 2.2 · χ² 1,128 / p 2e-247
2.1 EB05 2.0 · IC025 +1.0
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 2.6NCT00700427: 9/180 (5.0%) on Atomoxetine; 3/258 (1.2%) control
Vomiting1,5002.8
2.7–3.0ROR 3.0 · χ² 1,823 / p <1e-300
2.8 EB05 2.7 · IC025 +1.4
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.5NCT00700427: 1/180 (0.6%) on Atomoxetine; 3/258 (1.2%) control
Headache1,4712.1
2.0–2.2ROR 2.2 · χ² 853 / p 1e-187
2.1 EB05 2.0 · IC025 +1.0Labeled adverse reaction
exact term
serious PRR 3.3NCT00700427: 1/2,011 (0.0%) on Atomoxetine (serious AE)
Dizziness1,3962.5
2.4–2.6ROR 2.6 · χ² 1,269 / p 3e-278
2.5 EB05 2.4 · IC025 +1.2
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.7 · ♀ 64% (drug 42%)NCT00700427: 3/180 (1.7%) on Atomoxetine; 2/258 (0.8%) control
Somnolence (drowsiness)1,3606.0
5.7–6.4ROR 6.3 · χ² 5,717 / p <1e-300
6.0 EB05 5.7 · IC025 +2.5
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.1NCT00700427: 1/180 (0.6%) on Atomoxetine; 1/258 (0.4%) control
Insomnia (trouble sleeping)1,2614.2
4.0–4.4ROR 4.4 · χ² 3,102 / p <1e-300
4.2 EB05 4.0 · IC025 +2.0
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 4.4NCT00700427: 1/180 (0.6%) on Atomoxetine (serious AE)
Off label use (used outside approved label)1,2591.3
1.2–1.4ROR 1.3 · χ² 83 / p 4e-20
1.3 EB05 1.2 · IC025 +0.3Reporting / coding artifactserious PRR 2.7 · ♀ 73% (drug 42%)not reported in cached trials
Feeling abnormal1,1844.4
4.1–4.6ROR 4.6 · χ² 3,104 / p <1e-300
4.4 EB05 4.2 · IC025 +2.0
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 2.6 · 71% consumernot reported in cached trials
Depression1,1644.5
4.3–4.8ROR 4.7 · χ² 3,220 / p <1e-300
4.5 EB05 4.3 · IC025 +2.1
3/3 methods agree
Labeled — boxed warning
synonym match
serious PRR 6.4 · ♀ 64% (drug 42%)NCT00700427: 1/180 (0.6%) on Atomoxetine; 3/258 (1.2%) control
Abdominal pain upper1,1475.0
4.7–5.3ROR 5.2 · χ² 3,649 / p <1e-300
4.9 EB05 4.7 · IC025 +2.2
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 8.3 · ♀ 66% (drug 42%)NCT00700427: 38/2,011 (1.9%) on Atomoxetine
Prescribed overdose1,12954.9
51.7–58.2ROR 57.6 · χ² 56,195 / p <1e-300
51.7 EB05 49.2 · IC025 +5.6
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious PRR 26.6not reported in cached trials
Anxiety1,0423.2
3.1–3.4ROR 3.3 · χ² 1,633 / p <1e-300
3.2 EB05 3.1 · IC025 +1.6
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.2NCT00700427: 2/180 (1.1%) on Atomoxetine; 3/258 (1.2%) control
Suicidal ideation (thoughts of suicide)1,0059.8
9.2–10.4ROR 10.2 · χ² 7,894 / p <1e-300
9.7 EB05 9.2 · IC025 +3.2
3/3 methods agree
Labeled — boxed warning
exact term
serious PRR 12.8NCT00700427: 3/2,011 (0.1%) on Atomoxetine (serious AE)

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Atomoxetine ↔ Hypertension.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Atomoxetine?

In FDA FAERS, the most frequently co-reported reaction terms for Atomoxetine are fatigue, nausea, vomiting, headache, dizziness, somnolence. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Atomoxetine have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: SUICIDAL IDEATION IN CHILDREN AND ADOLESCENTS Atomoxetine increased the risk of suicidal ideation in short-term studies in children or adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Anyone considering the use of atomoxetine in a child or adolescent must balance this risk with the clinical need.

Do FAERS signals prove that Atomoxetine causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.