CBD and Atomoxetine (e.g. Strattera, Attentin)
David ReichUpdated:Key points at a glance:
CBD may inhibit the breakdown of atomoxetine via the enzyme CYP2D6. This could increase atomoxetine levels in the body and may be associated with a higher likelihood of side effects. Speak to a doctor before using them together. If advised to combine them, start with a low dose. Monitor blood pressure and heart rate. Have liver function checked as recommended by your healthcare professional. Taking the products at different times of day does not reliably avoid a potential interaction. The risk may be higher in people who are CYP2D6 poor metabolisers and in those also taking CYP2D6 inhibitors such as fluoxetine or paroxetine. Attentin contains dexamfetamine, not atomoxetine.
The use of CBD oil has increased significantly in recent years, and many people describe it as relaxing and helpful for sleep. If you are taking prescription medicines at the same time, it is important to be aware of possible CBD drug interactions. This article provides a concise, practical overview of what is known about using CBD and atomoxetine (Strattera) together, and how to approach this as safely as possible.
CBD may inhibit the breakdown of atomoxetine (mainly via the liver enzyme CYP2D6). The possible result is higher atomoxetine levels and an increased likelihood of side effects. Speak to your doctor beforehand, start with a low amount of CBD, and keep an eye on blood pressure, heart rate and liver function tests.
CBD can inhibit liver enzymes involved in the breakdown of atomoxetine (especially CYP2D6). This may increase atomoxetine levels and make side effects more likely, particularly in people who already metabolise atomoxetine slowly or take other CYP2D6 inhibitors. A cautious, medically supervised approach is recommended.
What is atomoxetine – and under which names is it available?
Atomoxetine is a selective noradrenaline reuptake inhibitor (NRI) used in the treatment of ADHD. In Europe and North America, the best-known brand name is Strattera. Important: Attentin is dexamfetamine and not atomoxetine – this name has sometimes been incorrectly associated with atomoxetine in some texts.
How does CBD work – and why is this relevant for atomoxetine?
CBD (cannabidiol) interacts with the body’s endocannabinoid system and is metabolised in the liver via cytochrome P450 enzymes. In laboratory studies, CBD has been shown to inhibit several of these enzymes, including CYP2D6, CYP3A4 and CYP2C19. These enzymes are important for the metabolism of many prescription medicines.
Atomoxetine is mainly broken down via CYP2D6. If CBD inhibits this enzyme, the breakdown of atomoxetine may slow down – a possible consequence is higher blood levels and therefore a higher likelihood of side effects. The potential risk is particularly relevant if you already metabolise via CYP2D6 more slowly due to genetic factors (so‑called poor metabolisers) or if you are also taking strong CYP2D6 inhibitors such as fluoxetine, paroxetine or quinidine.
CBD can inhibit CYP2D6, one of the main liver enzymes that metabolises atomoxetine. Because enzyme inhibition can persist, taking CBD and atomoxetine at different times of day does not reliably prevent a CBD–atomoxetine interaction.
Can CBD influence the effect of atomoxetine?
What role does the CYP2D6 enzyme play?
Atomoxetine is predominantly metabolised by CYP2D6. CBD inhibits this enzyme in vitro, which may slow the breakdown of atomoxetine. As a result, both the effects and side effects of atomoxetine could be more pronounced when CBD is used at the same time. Separating the intake times does not reliably prevent this potential risk because enzyme inhibition can last longer than the presence of CBD in the blood.
What are the potential risks when taking CBD and atomoxetine together?
In addition to possible cardiovascular effects (for example increased heart rate or blood pressure associated with atomoxetine), the liver is also an important consideration. Both CBD (especially in higher amounts) and atomoxetine have been associated with increased liver enzymes. In combination, an additive liver burden is conceivable. Discuss with your doctor whether and when liver function tests (ALT, AST, bilirubin) should be checked if you use CBD alongside atomoxetine/Strattera.
Warning signs to look out for
- Insomnia or inner restlessness
- Rapid heartbeat (tachycardia) or increased blood pressure
- Nausea or reduced appetite
- Liver-related symptoms: dark urine, pain or pressure in the upper abdomen, yellowing of the skin or eyes, pronounced fatigue
Who may be at higher risk from CBD–atomoxetine interactions?
- People with genetically reduced CYP2D6 activity (poor metabolisers)
- Those taking strong CYP2D6 inhibitors at the same time (for example fluoxetine, paroxetine, quinidine)
- Individuals with pre-existing liver conditions or previous increases in liver enzymes
- People using higher CBD amounts or increasing the CBD dose rapidly
Interaction overview: mechanism, possible consequences, what you can do
| Mechanism | Possible consequence | What you can do |
|---|---|---|
| CYP2D6 inhibition by CBD | Increased atomoxetine levels; restlessness, tachycardia, sleep disturbances | Consult a doctor, start with a low CBD dose, monitor blood pressure/heart rate, document symptoms |
| Additive liver burden | Increased liver enzymes, rarely liver injury | Check liver values before and after starting CBD; seek medical advice promptly if symptoms occur (for example dark urine) |
| Pharmacodynamic effects | Potentially opposing effects (CBD calming vs atomoxetine activating) | Keep intake times consistent, observe sleep quality and daytime alertness, inform your doctor if problems arise |
Practical steps if you are considering CBD with atomoxetine
- Inform your doctor about all medicines and supplements you use (including CBD products).
- Ask your doctor or pharmacist to review other CYP2D6 inhibitors you may be taking.
- Consider measuring blood pressure, heart rate and, if appropriate, liver values before starting CBD.
- Begin with a low CBD dose (for example 5–10 mg per day) and increase only slowly – always after discussing this with your doctor.
- Monitor blood pressure and heart rate daily for the first 1–2 weeks and watch for warning signs.
- Keep a simple record of dose, time of intake, symptoms and measurements for 2–4 weeks.
- If sleep is an issue with ADHD, some people prefer to take CBD in the evening. Note: timing does not reliably reduce enzyme-related CBD–atomoxetine interactions – medical supervision remains important.
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Side effects of CBD
CBD (cannabidiol) is a naturally occurring plant compound that many people use for balance and relaxation. Possible side effects include tiredness, dry mouth and dizziness; in some cases, blood pressure may temporarily decrease. Responses are individual – start low and pay attention to how you tolerate it. If you experience persistent or severe complaints, seek medical advice.
Side effects of atomoxetine (Strattera)
Commonly reported effects include sleep disturbances, loss of appetite, nausea and abdominal pain; headaches, dizziness and mood changes are occasionally described. In rarer cases, changes in blood pressure or heart function and increases in liver enzymes have been reported. Take atomoxetine exactly as prescribed and report side effects early. Regular check-ups can help to manage potential risks.
What do studies and professional information say about CBD–atomoxetine use?
Direct clinical evidence on the combination of CBD and atomoxetine is currently limited. Risk assessments are mainly based on pharmacokinetic data (CYP2D6 inhibition by CBD in vitro), known properties of atomoxetine (CYP2D6 metabolism, liver and cardiovascular safety aspects), as well as case reports and professional information. Expert sources (such as EMA/FDA product information on atomoxetine and reviews on CBD–enzyme interactions) support the recommendation to use the combination only with medical supervision, start with low CBD amounts and monitor vital signs and liver values.
There are hardly any direct clinical studies on CBD combined with atomoxetine. Existing data on CBD liver enzymes (including CYP2D6), together with atomoxetine product information, point towards a cautious, gradual approach with close medical monitoring of blood pressure, heart rate and liver values.
Atomoxetine is mainly broken down via CYP2D6, and CBD may inhibit this enzyme. The potential for increased atomoxetine levels is higher in CYP2D6 poor metabolisers or when strong CYP2D6 inhibitors (such as fluoxetine or paroxetine) are taken at the same time. Always involve your doctor, start CBD with a low dose, and monitor cardiovascular signs and liver function.
Key considerations before combining CBD and atomoxetine
- Speak to your doctor before starting CBD and provide a full list of your medicines and supplements.
- Consider having blood pressure, heart rate and liver values measured beforehand and checked again after 2–4 weeks.
- Start low with CBD (for example 5–10 mg per day) and only increase after medical advice.
- Watch for warning signs: persistent insomnia, rapid heartbeat, increased blood pressure, nausea, upper abdominal pain or dark urine.
Disclaimer: This article is for information purposes only and does not replace medical advice. Do not change medicines or dosages without consulting your doctor. No claims are made regarding the treatment or cure of illnesses.