Which of the following medications is a non-stimulant first-line agent for ADHD and works primarily by inhibiting norepinephrine reuptake?

Explanation

## Non-Stimulant ADHD Medications: Atomoxetine **Key Point:** Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) and is the first non-stimulant FDA-approved medication for ADHD in children and adults. ### Mechanism of Action **High-Yield:** Atomoxetine selectively blocks the norepinephrine transporter (NET) in the prefrontal cortex and other brain regions, increasing synaptic norepinephrine availability. This enhances executive function and impulse control without the abuse potential of stimulants. ### Clinical Characteristics | Feature | Atomoxetine | | --- | --- | | **Drug class** | Selective NRI (non-stimulant) | | **Onset of action** | 2–4 weeks (slower than stimulants) | | **Abuse potential** | None (Schedule IV) | | **Dosing** | Once or twice daily | | **Key advantage** | No cardiovascular stimulation, lower abuse risk | | **Common side effects** | Nausea, decreased appetite, insomnia, mood changes | | **Contraindications** | Narrow-angle glaucoma, concurrent MAOI use | ### Comparison with Other Non-Stimulants **Clinical Pearl:** While bupropion and guanfacine are used off-label or as adjuncts in ADHD, atomoxetine is the only non-stimulant with FDA approval as a first-line monotherapy for ADHD. ### Mnemonic **ATOM = Atomoxetine Treatment Option for ADHD Monotherapy** - **A**tomoxetine - **T**argets **N**orepinephrine - **O**ne of the few non-stimulant **M**onotherapies approved **Tip:** On NEET PG, when asked about "non-stimulant first-line ADHD agent," atomoxetine is the textbook answer. Guanfacine and clonidine are alpha-2 agonists used as adjuncts or in specific cases (e.g., comorbid tics or oppositional defiant disorder).