Norepinephrine Transporter Blockade, Autonomic Failure (NETAF)

Inclusion Criteria: * 40 years old or older * Neurogenic Orthostatic Hypotension (defined by a reduction of ≥20 mmHg drop in SBP within 3 minutes of standing, associated with impaired autonomic reflexes as assessed by autonomic function tests. Exclusion Criteria: * Pregnancy or breastfeeding * Hypersensitivity to atomoxetine (severe allergic reaction, rash, urticaria, anaphylaxis) * Use of other norepinephrine transporter inhibitors such as Wellbutrin (Bupropion), Cymbalta (Duloxetine), Effexor (venlafaxine), Pristiq (desvenlafaxine), Savella (milnacipran) * Previous history (within 14 days prior to enrollment) and current use of monoamine oxidase inhibitors * Concomitant use of strong CYP2D6 inhibitors such as delavirdine, paroxetine, fluoxetine, quinidine * Pre-existing sustained severe hypertension (BP ≥ 140/80 mmhg in the sitting position) * Impaired hepatic function (aspartate amino transaminase \[AST\] and/or alanine amino transaminase \[ALT\] \>2 x upper limit of normal range) * Impaired renal function (serum creatinine equal or more than 1.6 mg/dl) * Myocardial infarction within 6 months prior to enrollment * Congestive heart failure (LV hypertrophy acceptable) * History of serious neurologic disease such as cerebral hemorrhage, or stroke * Inability to comply with the protocol, e.g., uncooperative attitude, inability to return for follow-up visits, unlikelihood of completing the study, and mental conditions rendering the subject unable to understand the nature, sc…