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Summary   Aim  To compare atomoxetine ( ATX ) length of therapy (LoT) among adults with  ADHD  who reached the recommended dose of 80 mg/day ( ATX  ≥ 80) versus those who did not ( ATX  < 80) analyzed separately in patients prescribed  ATX  as monotherapy (mono) and in combination with other  ADHD  medications (combo).    Methods  This was a retrospective observational cohort study of the Truven Health Marketscan Commercial Claims Database from January 1, 2006–September 30, 2013, with a 6‐month preindex period free of  ATX  (1st  ATX  claim as index event) and a 1‐year follow‐up. LoT during follow‐up was calculated using prescription claim fill dates and included all days with medication on hand regardless of treatment gaps.    Results  Only 45.0% of the 36,076 mono and 77.9% of the 1548 combo patients reached an  ATX  dose of ≥80 mg/day in 1‐year follow‐up. When patients filled at least one 80 mg prescription, their total days of therapy over the course of a year were significantly greater than if they did not (mono: 159.3 vs. 65.6 days; combo: 237.4 vs. 172.0;  P  < 0.0001). Across all timepoints examined (Day 14, 30, 60, 90, 210) for mono and combo,  ATX  ≥ 80 versus  ATX  < 80 patients had greater mean doses ( P  < 0.0001). Combo patients had longer  ATX  LoT than mono patients regardless if they reached 80 mg or not ( P  < 0.0001), but mono patients LoT was 93.8 days longer for  ATX  ≥ 80 versus  ATX  < 80 patients compared to 65.5 days for combo patients. Of patients reaching 80 mg/day, 71.7% of mono and 62.8% of combo patients did so by Day 30. For mono  ATX  ≥ 80 and  ATX  < 80 patients, LoT was significantly ( P  < 0.0001) less in previously treated patients compared to naive patients.    Conclusion  Ensuring adult  ADHD  patients are treated with  ATX  at a target dose of 80 mg/day is an important clinical consideration for maximizing patient days on therapy, which can be important for treatment optimization.

Clinical Impact of Not Achieving Recommended Dose on Duration of Atomoxetine Treatment in Adults with Attention‐Deficit/Hyperactivity Disorder