Medication and Treatment Reviews

Strattera

Generic Name: Atomoxetine hydrochloride

Uses

Strattera, known as atomoxetine hydrochloride in its generic form, is an effective and safe alternative to the stimulant medications most commonly used to treat attention deficit hyperactivity disorder (ADHD) in children ages 6-12, adolescents, and adults. It is a selective norepinephrine reuptake inhibitor (SNRI) medicine. Strattera is not considered a controlled substance by the Drug Enforcement Agency (DEA). It has not been studied in children under the age of 6.

Strattera was the first non-stimulant approved for treatment of ADHD in the United States by the Food and Drug Administration (FDA). Stimulant medications are often the first-recommended treatment, but Strattera is a good alternative for people who cannot tolerate, or don’t experience the desired effects of, stimulant medication.

The American Academy of Pediatrics recommends treatment with behavioral therapy before medication for children under the age of 6. For children ages 6 to 11, the AAP says “The primary care clinician should prescribe US Food and Drug Administration–approved medications for ADHD and/or evidence-based parent- and/or teacher-administered behavior therapy as treatment for ADHD, preferably both.” Likewise, the National Institute of Mental Health finds the most successful treatment plans use a combination of ADHD medication, like Strattera, and behavior therapies.

How to Use Strattera

Before starting or refilling an Strattera prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your or your child’s medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

Dosage

As with all medications, follow your Strattera prescription instructions exactly.  Strattera is taken orally, with or without food, once or twice daily. The first dose is typically taken first thing in the morning. If a second dose is prescribed, it is typically taken in the late afternoon or early evening. It should be taken at the same time each day for the best results.

Capsules should be swallowed whole with water or other liquids. Capsules should never be opened, crushed, or chewed. If your child is unable to swallow the capsule, discuss a different medication with your doctor.

Capsules are available in 10mg, 18mg, 25mg, 40mg, 80mg, and 100mg dosages. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day.

The optimal dosage varies patient by patient. Your doctor may adjust your daily dosage after 3 days until you or your child experiences the best response — that is, the lowest dosage at which you experience the greatest improvement in symptoms without side effects. The maximum recommended dosage is 100mg/day.

During treatment, your doctor may periodically ask you to stop taking your Strattera so that he or she can monitor ADHD symptoms; check vital statistics including blood, heart, and blood pressure; or evaluate height and weight. If any problems are found, your doctor may recommend discontinuing treatment.

Side Effects

The most common side effects of Strattera are as follows:

Children and adolescents (ages 6 – 17): upset stomach, decreased appetite, nausea, and vomiting.

Adults: constipation, dry mouth, nausea, decreased appetite, dizziness, sexual side effects, and problems passing urine.

Other serious side effects include the following: severe allergic reaction, slowed growth in children, priapism, and difficulty urinating including trouble starting and emptying the bladder. Seek immediate medical attention if you have trouble breathing, see swelling or hives, or experience any other signs of an allergic reaction.

Taking Strattera may impair your or your teenager’s ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor. Most people taking this medication do not experience any of these side effects.

Disclose to your physician all mental health issues including any family history of suicide, bipolar illness, or depression. The FDA recommends evaluating patients for bipolar disorder prior to administration of Strattera to avoid inducing a manic episode. Strattera may create new or exacerbate existing behavior problems, bipolar disorder, or suicidal ideation. It can cause psychotic or manic symptoms in children and teenagers. Call your doctor immediately if you or your child experiences new or worsening mental health symptoms including anxiety, hearing voices, agitation, panic attacks, trouble sleeping, irritability, hostility, aggressiveness, or depression.

Discuss any existing liver problems with your doctor. Strattera can cause severe liver injury for some patients. Contact your doctor immediately if you or your child experiences these signs of liver problems: itching, right upper belly pain, dark urine, yellow skin or eyes, or inexplicable flu-like symptoms.

Report to your doctor any heart-related problems or a family history of heart and blood pressure problems. Patients with structural cardiac abnormalities and other serious heart problems have experienced sudden death, stroke, heart attack, and increased blood pressure while taking Strattera. Physicians should monitor these vital signs closely during treatment. Call your doctor immediately if you or your child experiences warning signs such as chest pain, shortness of breath, or fainting while taking Strattera.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Precautions and Safety

Store Strattera in a secure place out of the reach of children, and at room temperature. Do not share your Strattera prescription with anyone, even another person with ADHD. Sharing prescription medication is illegal, and can cause harm.

You should not take Strattera if you have:

  • taken, or plan to take an antidepressant monoamine oxidase inhibitor or MAOI within 14 days
  • narrow angle glaucoma
  • an allergy to any ingredients
  • a rare tumor called pheochromocytoma

If you’re thinking of becoming pregnant, discuss the use of Strattera with your doctor. Animal studies indicate a potential risk of fetal harm; infants may be born prematurely, with low birth weight, with spinal abnormalities, or experience withdrawal. Strattera is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.

The effects of Strattera on children under 6 and on the elderly have not been studied.

Interactions

Before taking Strattera, discuss all other active prescription medications with your doctor. Strattera can have a dangerous interaction with antidepressants including MAOIs, asthma medicines, blood pressure medicines, and cold or allergy medicines that contain decongestants.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking Strattera before having any surgery or laboratory tests. The above is not a complete list of all possible drug interactions.

Sources:

http://pi.lilly.com/us/strattera-ppi.pdf
http://www.fda.gov/downloads/drugs/drugsafety/ucm089138.pdf
http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021411s035lbl.pdf

14 reviews

  1. My 12 year old son has been taking Strattera for 5 weeks now. He started with 2 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. 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 3 days. My son moved up to the 25 mg dose last Friday. On Saturday he seemed more unfocused. There did not seem to be any extra anxiety or any other side effects this time.

  2. My 8 year old daughter was taking two 25mg pills every morning and then Intuniv 3mg at night. She started having severe stomach cramps daily. We switched the Strattera to 25mg in the morning and 25mg at night and now she rarely has stomach cramps.

  3. My son takes Straterra and we are having success with one exception, stomach problems. The problem was the dye used in the capsules and not the medication itself.

  4. My 9 year old daughter is up to 25 mg of Strattera. However, there are some nights when she wakes up in the middle of the night and cannot fall back to sleep for long periods of time.

  5. I am male and 55 years old recently diagnosed with ADHD. I am on 80 mg of Strattera. It has helped much with anxiety and impulsivity. I am having negative side effects: I feel more spacey, food tastes bland and my appetite has decreased.

  6. I am 39 and newly diagnosed. I started on Strattera this past weekend and am on 40 mg twice a day as of two days ago. I was very drowsy the first two days, but it hasn’t been that bad since. On the other hand, I haven’t noticed much other difference in my attention or organizational capacity, either.

  7. I am taking 18mg once per day and this is the second week. The first week I had insomnia like crazy and lately I have been sleeping more than ever in my life.

  8. I am 56 year old Retired Special Ed teacher, and have been taking 40mg BID Strattera for over 5 years—works great for me. However, I did develop a small facial tic (excessive eye blinking).

  9. I am a 52 year old female with ADHD, and I take 60mg of Strattera daily, and the only problem I have with mine is occasionally I have dry cotton mouth. I have been taking it now for 5 years.

  10. I am on 40mg Strattera as well as 30mg Vyvanse. The first few weeks of Strattera were a little rocky, but four months into it, I am very pleased with it. However, the Vyvanse gets me motivated and the Strattera helps me to focus.

  11. I started at 40 mg and had a crazy over-the-top response to it (stared at a wall in bed for several hours). Now I’m on 10 mg. If I take it at night (after 5:00pm), I feel pretty good except for a little dry mouth and insomnia. However if I take it first thing in the morning, I spend the majority of the morning and early afternoon exhausted and kind of out of it.

  12. I’m 38 years old. And last month I diagnosed ADHD. I started Strattera 40mg, I don’t have a effectiveness yet, but I feel very strong sleepiness all day as side effect.

  13. I started at 18mg and worked up to 60mg over the course of a month. I felt restless and cranky all the time. However, now that it is fully kicked in (I’ve been on it for about 4 months), it is worth it.

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