Non-stimulant attention deficit medication Strattera can treat distractibility, impulsivity, and hyperactivity in children, teens, and adults with ADHD. Dr. Larry Silver explains what doctors know about ADHD treatment using Strattera.
by Larry Silver, M.D.
Strattera, the brand name of the drug atomoxetine, is a non-stimulant medication for attention deficit hyperactivity disorder that treats distractibility, impulsivity, and hyperactivity in children, teens, and adults with ADHD. 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.
Strattera was approved by the FDA in 2006.
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'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 ADHD teens and adults. Safety and effectiveness have not been established in patients less than six years of age.
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. Strattera takes from one to four weeks to work. Since it is not a stimulant medication, prescriptions can be called into the pharmacist and renewals can be written for it.
Capsules are available in 10, 18, 25, 40 and 60 mg strengths.
The initial dose is 0.5 mg/kg. The targeted clinical dose is approximately 1.2 mg/kg. The dose is based on body weight. After four weeks, the dose can be increased.
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 impulsivity. The early literature proposes that Strattera might improve problems with organization.
Adults and children ages 6 and over are able to safely take Strattera.
Children or adults who are taking or have taken in the past 14 days a type of antidepressant known as a monoamine oxidase inhibitor, or MAOI, should not take Strattera. Patients with a condition called narrow angle glaucoma, or who have had the rare tumor pheochromocytoma, should not take Strattera.
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 a non-stimulant medication and has a much lower risk of addiction and abuse than other common ADHD medications.
Strattera is a Class C drug, meaning its risk during pregnancy cannot be ruled out. Talk to your doctor about your decision to discontinue or continue Strattera while you are pregnant or breastfeeding.
Some insurance companies cover Strattera completely or require a small copay. Check with your provider to see if Strattera is available under your plan. Strattera offers a savings program to eligible patients; visit their website for more details.
No major side effects so far
My 12-year-old son has been taking Strattera for 5 weeks now. He started with two weeks of 10mg, then moved up to 18 mg, and he will be on that for another week before ramping up again. He has had no side effects so far. I think we are finally starting to see some improvement in his symptoms after 5 weeks...he seems calmer and more focused.
I had read online that common side effects are sleepiness and stomach aches, so we are giving him the Strattera every night after dinner. He sleeps great at night and has had no stomach problems.
I did notice that he seemed a little more anxious and withdrawn after starting the 10 mg and again after starting the 18 mg, but that went away after about three days. I will see what happens when he ramps up again to 25 mg.
Some stomach cramps
My 8-year-old daughter has been on Strattera for about a year now. We have changed the dosages a few times but have ended up at 50mg per day. The only problem we have noticed is that she started having severe stomach cramps daily. She was taking 2 -25mg pills every morning and then and Intuniv 3mg at night. After talking to her doctor, we switched the Strattera around to 25mg in the morning and 25mg at night…........she very rarely has stomach cramps anymore, thank goodness!!
Bad news for bipolar patients
Based on my experience and the many posts I have found online, Strattera is not usually a good idea for people with Bipolar Mood Disorder and ADD or ADHD. I noted on the flyer that it isn’t advised for bipolar people, but I trusted my psychiatrist, who is rated one of the best in the U.S. I also noticed the Strattera paperwork said it makes kids and teens suicidal, but it didn’t say adults. I failed to draw the logical conclusion that it might similarly affect adults.
My psychiatrist said Strattera is the only ADHD drug that’s really safe to try with someone who has bipolar mood disorder. It isn’t an amphetamine (stimulants can make us manic, and it’s harder to bring down a manic person than to elevate a depressed person).
Strattera has been a nightmare for me and for a lot of other bipolar people — there is a site where patients can post their reactions to drugs, and many bipolar folks posted reactions to Strattera that are horrific. Some folks had to be hospitalized for months, some lost their marriages, others their jobs, still others their houses — all due to what I experienced: extreme suicidality and ultra-ultra-rapid cycling, meaning extreme mood swings 3-4 times a day. It’s a special kind of hell I wouldn’t wish on anybody (btw, my normal mood swings cycle in fall and spring, i.e. twice a year).
Strattera was like a relentless demon on my shoulder; it would repeat to me every 15 seconds that I should kill myself even when I wasn’t feeling depressed. I was completely dysfunctional (my house and finances are still a wreck), unable to work, and lost nine dear friends as a result of mental-emotional instability they’d never seen before.
I’ve been off Strattera for eight months now and am down to usually one mood swing per day, which is still rapid cycling — just not ultra-ultra rapid. I thank God it is slowing down, but it is doing so very, very slowly as if my emotional pendulum had been swung so hard it has taken eight months just to gradually slow itself down enough to feel somewhat normal. I still don’t trust my emotional stability enough to go try to repair my broken friendships, although I miss my former friends terribly.
I’m glad to hear the drug is helpful for some people. Wouldn’t advise it for bipolars (and wouldn’t advise it because I don’t have a medical degree!)
Strattera is manufactured by Eli Lilly and Company. For more information, visit the patient and healthcare professional website.