Strattera (atomoxetine) and Adderall (mixed amphetamine salts) are both FDA-approved treatments for attention-deficit/hyperactivity disorder (ADHD), but they work in very different ways. Adderall is a stimulant that starts working within about an hour and wears off the same day, while Strattera is a non-stimulant that builds up slowly over weeks and works around the clock. Knowing how these two medications differ can help you have a more informed conversation with your prescriber about which one may fit your life.
Key Takeaways
Stimulant versus non-stimulant: Adderall raises dopamine and norepinephrine and often starts working within 30 to 60 minutes. Strattera primarily raises norepinephrine and usually takes four to eight weeks to reach its full effect.
Effectiveness and personal fit: Adderall may produce larger symptom improvements than Strattera. Even so, many people can do better on Strattera.
Controlled substance status: Adderall is a Schedule II medication with refill limits and a real risk of misuse. Strattera is not a controlled substance, which can make access and monitoring simpler.
How Strattera and Adderall Work Differently
While both medications can be effective for ADHD, they use different mechanisms to improve attention and reduce impulsivity.
Strattera (Atomoxetine)
Strattera was approved by the FDA in 2002 and was the first non-stimulant approved for ADHD. It is a selective norepinephrine reuptake inhibitor (SNRI), which means it blocks the reuptake of norepinephrine, leaving more of it available in the brain, especially in the prefrontal cortex, the area that helps manage attention and impulse control.
As Strattera has no direct effect on the brain’s reward pathways, it does not cause a euphoric high and is therefore not a controlled substance. It is approved for ADHD in adults and children aged six and older. Strattera is taken once or twice a day and works continuously, including in the evenings.
When Strattera May Fit Better
Strattera may be the preferred choice if you have a history of substance use, since it has no meaningful misuse potential. It can also be a better fit if you have co-occurring anxiety, because stimulants can make anxiety worse for some people. Strattera is often preferred for people with tics or Tourette syndrome, for those who need steady evening and weekend coverage, and for anyone who cannot tolerate stimulant side effects.
Adderall (Mixed Amphetamine Salts)
Adderall contains four amphetamine salts in a roughly 3 to 1 mix of dextroamphetamine to levoamphetamine. It increases the release of dopamine and norepinephrine and blocks their reuptake. This helps to sharpen focus and lowers impulsivity and restlessness.
Adderall comes as an immediate-release tablet that can last about four to six hours and an extended-release capsule (Adderall XR) that lasts closer to 10 to 12 hours. The FDA classifies it as a Schedule II controlled substance because it carries a potential for abuse, misuse, and addiction.
When Adderall May Fit Better
Adderall may be the better option if you need results quickly, since it works the first day while Strattera can take up to two months. It is also a reasonable choice if a stimulant has worked well for you before, if your symptoms cluster in specific hours such as a workday or school day, or if a full trial of Strattera did not help.
Strattera vs Adderall: Key Differences at a Glance
Before getting into dosing and side effects, here is a quick look at the differences that tend to matter most day to day:
Drug class: Strattera is a non-stimulant, while Adderall is a stimulant.
Onset: Strattera can take one to four weeks for early changes and four to eight weeks for the full effect. Adderall usually works within 30 to 60 minutes.
Coverage: The effects of Strattera can last up to a day, while Adderall works only while it is active in your system.
Controlled status: Strattera is not a scheduled drug, while Adderall is listed as a Schedule II drug.
Misuse potential: Strattera has essentially no misuse potential. Adderall carries a meaningful risk.
Appetite and sleep: Both can lower appetite. Adderall is more likely to disrupt sleep if taken late in the day.
Dosing for Strattera and Adderall
Adderall and Strattera have different dosing schedules and are started and adjusted in different ways.
Strattera Dosing
Strattera is available in capsules of 10, 18, 25, 40, 60, 80, and 100 mg. For children and teens who weigh up to 70 kg (about 154 pounds), the starting dose is usually 0.5 mg per kg each day, with a target of about 1.2 mg per kg and a maximum of 1.4 mg per kg. For children and teens over 70 kg and for adults, treatment usually starts at 40 mg per day, moves to a target of 80 mg per day, and can go up to a maximum of 100 mg per day.
Adderall Dosing
For adults, immediate-release Adderall often starts at 5 mg once or twice a day, and a provider may raise it by 5 mg each week until it works well. Most adults do not need more than 40 mg a day. Extended-release Adderall XR is taken once each morning. Pediatric dosing is lower and weight-based, and the FDA label caps most children and teens at 30 mg a day for the extended-release form.
If you ever suspect your dose is off, there are signs your ADHD medication dose may be too low that are worth discussing with your provider rather than adjusting on your own.
How Effective Are Strattera and Adderall for ADHD?
Both Adderall and Strattera can be effective for treating ADHD, but they may not work equally well for everyone.
What Research Suggests
A large study comparing ADHD medications in children, teens, and adults found that amphetamines (Adderall) produced larger improvements in ADHD symptoms than atomoxetine (Strattera) in children and adolescents and adults. Moreover, stimulants (Adderall) tend to have greater efficacy and act almost immediately, while atomoxetine (Strattera) can take several weeks to show its full benefit.
It is, however, crucial to note that results from large studies show what works on average, but they cannot predict how one person will respond. Some people do not get enough benefit from stimulant medications, have bothersome side effects, or have medical reasons to avoid them. In those cases, atomoxetine may be a better option. Even though atomoxetine is a non-stimulant, it can still cause side effects, so your healthcare provider will monitor things like your blood pressure, heart rate, and weight while you're taking it.
Side Effects of Strattera vs Adderall
Adderall and Strattera have different side effect profiles, so it's important to know what to expect with each.
Common Strattera Side Effects
The most common effects include nausea, dry mouth, lower appetite, tiredness or drowsiness, dizziness, and stomach upset. Adults may also notice urinary hesitancy or sexual side effects. Strattera carries a boxed warning about increased suicidal thinking in children and teens, and in rare cases it has been linked to liver injury, so yellowing of the skin or eyes or dark urine should be reported right away.
Common Adderall Side Effects
Typical effects include reduced appetite, trouble falling asleep, dry mouth, headache, irritability, anxiety, and a higher heart rate and blood pressure. A late-afternoon "crash" as the dose wears off is common with Adderall and is not something Strattera tends to cause. Adderall carries a boxed warning about abuse, misuse, and addiction.
Heart-Related Cautions for Both
Strattera and Adderall can both raise heart rate and blood pressure. They should be used carefully in people with existing heart conditions. Healthcare providers must carefully review a patient’s heart history before starting these medications
If you are trying to decide between these two medications, a psychiatric provider can help you weigh the tradeoffs against your health history and goals. You can get started with Blossom Health to connect with an in-network provider who prescribes and monitors ADHD medication through virtual visits.
Can You Take Strattera and Adderall Together?
Sometimes, yes. A provider may combine Adderall with Strattera when a stimulant helps during the day, but symptoms return in the evening, or when a stimulant only helps part of the way. This is an off-label approach and calls for close monitoring of heart rate, blood pressure, and side effects. It is not something to try on your own, because both medications raise norepinephrine, and combining them without supervision can add to cardiovascular strain. If you prefer to avoid stimulants entirely, there are other non-stimulant ADHD medication options a provider can review with you.
When to Seek Medical Attention
Contact your provider promptly if you have chest pain, fainting, or shortness of breath on either medication. For Strattera, yellowing of the skin or eyes, dark urine, or pain in the upper right side of your abdomen can signal a liver problem and can need same-day attention.
For Adderall, signs of misuse, a quickly climbing need for higher doses, or new paranoia or hallucinations deserve an immediate call. Both medications can, in rare cases, trigger new manic or psychotic symptoms. If you or someone close to you notices a dramatic change in personality, do not wait for the next scheduled visit. If you are having thoughts of harming yourself, call or text 988.
At Blossom Health, our board-certified psychiatric providers work with you to find the medication and dose that best fits your needs while closely monitoring your progress and any side effects. Through convenient virtual appointments, you'll receive personalized treatment, ongoing medication management, and support every step of the way so you can manage your ADHD with confidence. To learn more, visit https://www.joinblossomhealth.com/start.
Medical Disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice. Always talk with your physician or another qualified healthcare provider about any questions you have regarding a medical condition or medication, and never start, stop, or change a prescription without guidance. If you are experiencing a mental health crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.
Sources
U.S. Food and Drug Administration. Strattera (atomoxetine) capsules: Prescribing information. accessdata.fda.gov
U.S. Food and Drug Administration. Adderall (mixed amphetamine salts) tablets: Prescribing information. accessdata.fda.gov
U.S. Food and Drug Administration. Adderall XR extended-release capsules: Prescribing information. accessdata.fda.gov
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