NutriStack
Atomoxetine and Cocaine, a caution.
Atomoxetine and cocaine both increase noradrenergic cardiovascular stress. A monitored inpatient study in cocaine-experienced participants found atomoxetine plus intravenous cocaine was tolerated at tested doses, but cocaine still produced heart-rate and blood-pressure responses; a later abstinent-user study found atomoxetine increased heart rate and systolic blood pressure versus placebo. Real-world cocaine dose, route, adulterants, and redosing make co-use unsafe outside monitored research conditions.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Atomoxetine and Cocaine
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 3 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Atomoxetine and cocaine both increase noradrenergic cardiovascular stress. A monitored inpatient study in cocaine-experienced participants found atomoxetine plus intravenous cocaine was tolerated at tested doses, but cocaine still produced heart-rate and blood-pressure responses; a later abstinent-user study found atomoxetine increased heart rate and systolic blood pressure versus placebo. Real-world cocaine dose, route, adulterants, and redosing make co-use unsafe outside monitored research conditions.
Mechanism. Atomoxetine inhibits the norepinephrine transporter and can increase blood pressure and heart rate. Cocaine blocks norepinephrine, dopamine, and serotonin reuptake, increases sympathetic outflow, causes vasoconstriction, and can impair cardiac conduction through sodium-channel blockade, creating additive cardiovascular and neuropsychiatric toxicity potential.
Recommendation. Avoid cocaine while taking atomoxetine. Do not take extra atomoxetine to offset cocaine crash, fatigue, or attention problems. Seek emergency care for chest pain, severe headache, fainting, severe agitation, shortness of breath, or a fast or irregular heartbeat.
Sources (3)
- Cantilena L, Kahn R, Duncan CC et al.. Safety of atomoxetine in combination with intravenous cocaine in cocaine-experienced participants. Journal of addiction medicine. 2012 Dec;6(4):265-73. PMID 22987022
- DeVito EE, Herman AI, Konkus NS et al.. Atomoxetine in abstinent cocaine users: Cognitive, subjective and cardiovascular effects. Pharmacology, biochemistry, and behavior. 2017 Aug;159:55-61. PMID 28716656
- Kim ST, Park T. Acute and Chronic Effects of Cocaine on Cardiovascular Health. International journal of molecular sciences. 2019;20(3):584. PMID 30700023
Stack Score
How this pair moves the number.
Effect on the composite score
If both Atomoxetine and Cocaine are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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