Strattera: What You Need to Know
Q:
Read what Dr. Larry Silver has to say on what doctors know so far about this nonstimulant treatment. 
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What is Strattera?Strattera may turn out to be the best first line medication for treating ADHD, but it is too early to separate out the claims from clinical experience. Strattera is advertised as the first non-stimulant medication for ADHD, although there are several non-stimulant medications, such as Tri-cyclic Antidepressants, that are sometimes prescribed to treat ADHD. How does it work?Strattera's structure, models of action, length of time needed to work, and side effects are in many ways similar to a group of medications for depression and other disorders called "Selective Serotonin Reuptake Inhibitors," or SSRIs. In fact, it was first studied as a treatment for depression. When it was not found to be successful, it was tried for ADHD. Strattera is approved for use with children aged 6 years and older, as well as adolescents and adults. Safety and effectiveness have not been established in patients less than six years of age. How is it taken?Strattera takes from one to four weeks to work. The dose is based on body weight. After four weeks, the dose can be increased. Capsules are available in 10, 18, 25, 40 and 60 mg strengths. Since it is not a stimulant medication, prescriptions can be called into the pharmacist and renewals can be written for it. The initial dose is 0.5 mg/kg. The targeted clinical dose is approximately 1.2 mg/kg. Medication is given in the morning and must be used each day. When higher doses are needed, the amount needed can be divided into two doses, one in the morning and one in the evening. The suggested plan is to use a starting dose for four days and then move up to the target dose. After a month, the dose might be increased again. The goal is to decrease the level of hyperactivity, distractibility and/or impulsivity. The early literature proposes that Strattera might improve organizational problems. Are there any side effects?The most common side effects are decreased appetite, nausea, vomiting, fatigue, dyspepsia (indigestion), dizziness and mood swings. If these side effects occur, it is recommended that the medication be continued for a short period of time to see if they decrease or go away. If they do not, the medication needs to be discontinued. Work with your family physician and let the clinical benefits noted with your child guide you. Strattera is manufactured by Eli Lilly and Company. For more information, visit the patient and healthcare professional website at http://www.strattera.com.
Larry Silver, M.D., is the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities. He is also a clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C.
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