Strattera: Non-Stimulant ADHD Symptom Control for Sustained Focus
Strattera
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| Product dosage: 18mg | |||
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Synonyms | |||
Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor (SNRI) approved for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents, and adults. Unlike traditional stimulant medications, it offers a non-controlled substance option with 24-hour symptom coverage from a single daily dose. Its unique mechanism targets core ADHD impairments in executive function, emotional regulation, and attentional control without abuse potential, making it a first-line choice for patients with comorbid substance use concerns or unsatisfactory stimulant response.
Features
- Active ingredient: Atomoxetine hydrochloride
- Pharmacologic class: Selective norepinephrine reuptake inhibitor (SNRI)
- Available strengths: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg capsules
- Administration: Oral, once or twice daily dosing
- Onset of action: Therapeutic effects typically observed within 2-4 weeks
- Duration: 24-hour continuous symptom coverage
- Formulation: Enteric-coated capsules containing powder or pellets
- Prescription status: Non-controlled prescription medication (no Schedule classification)
Benefits
- Provides continuous ADHD symptom control without stimulant-related rebound effects or abuse potential
- Improves executive functioning including working memory, planning, and organizational skills
- Reduces emotional lability and rejection sensitive dysphoria commonly associated with ADHD
- Eliminates the stigma and regulatory burdens associated with controlled substances
- Offers single-daily dosing convenience for consistent therapeutic coverage
- Demonstrates efficacy in ADHD with comorbid anxiety disorders where stimulants may exacerbate symptoms
Common use
Strattera is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in patients aged 6 years and older. It is particularly valuable for patients who cannot tolerate stimulant medications, have a history of substance use disorder, or experience inadequate response to methylphenidate or amphetamine-based treatments. Clinical applications extend to patients with comorbid tic disorders, anxiety disorders, or cardiovascular concerns that contraindicate stimulant use. The medication addresses core ADHD symptoms including inattention, hyperactivity, impulsivity, and associated emotional dysregulation.
Dosage and direction
Initial dosing: For children and adolescents up to 70 kg body weight: Start with 0.5 mg/kg/day for minimum of 3 days before increasing to target dose of 1.2 mg/kg/day. For patients over 70 kg and adults: Initial dose of 40 mg daily for minimum of 3 days before increasing to target dose of 80 mg daily. Maximum recommended daily dose: 100 mg or 1.4 mg/kg, whichever is less.
Administration: Swallow capsule whole with water. May be taken with or without food, though consistent administration with food may reduce gastrointestinal discomfort. For once-daily dosing, administer in the morning; for twice-daily dosing, administer initial dose in morning and second dose in late afternoon/early evening. Do not open, crush, or chew capsules as this may affect the controlled-release properties.
Titration: Dose adjustments should occur at intervals of no less than 3 days based on clinical response and tolerability. Therapeutic effects may require 2-4 weeks of consistent dosing at therapeutic levels.
Precautions
Hepatic impairment: Dose reduction necessary in patients with moderate to severe hepatic impairment (Child-Pugh Class B or C). Monitor for increased adverse effects.
Cardiovascular monitoring: Assess blood pressure and heart rate at baseline and periodically during treatment. Use caution in patients with hypertension, tachycardia, or cardiovascular disease.
Psychiatric monitoring: Monitor for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, mania, or suicidal ideation, particularly during initial titration and dose adjustments.
Growth monitoring: Monitor height and weight in pediatric patients. Temporary growth suppression may occur, though catch-up growth typically follows.
Discontinuation: Taper gradually rather than abrupt discontinuation to minimize potential withdrawal symptoms including irritability and anxiety.
Contraindications
- Hypersensitivity to atomoxetine or any component of the formulation
- Concurrent administration with monoamine oxidase inhibitors (MAOIs) or within 14 days of MAOI discontinuation
- Narrow-angle glaucoma
- Pheochromocytoma or history of pheochromocytoma
- Severe cardiovascular disorders that would be exacerbated by increases in blood pressure or heart rate
- Severe hepatic impairment (Child-Pugh Class C)
Possible side effects
Common (≥5%): Decreased appetite (15-20%), nausea (10-15%), fatigue (8-10%), dizziness (5-8%), dry mouth (15-20%), insomnia (10-15%), abdominal pain (10-15%), vomiting (5-10%), constipation (5-8%), dyspepsia (5%), mood swings (5-8%)
Less common (1-5%): Palpitations, tachycardia, hypertension, hot flashes, urinary hesitation/retention, erectile dysfunction, delayed ejaculation, menstrual cramps, irritability, anxiety
Rare (<1%): Severe liver injury (hepatotoxicity), allergic reactions including angioedema, rash, urticaria, priapism, Raynaud’s phenomenon, suicidal ideation (particularly in children and adolescents)
Drug interaction
MAO inhibitors: Contraindicated due to risk of serotonin syndrome and hypertensive crisis CYP2D6 inhibitors: Strong inhibitors (paroxetine, fluoxetine, quinidine) may increase atomoxetine levels requiring dose adjustment Albuterol: May potentiate cardiovascular effects including increased heart rate and blood pressure Pressor agents: May potentiate effects on blood pressure Antihypertensics: May reduce efficacy of blood pressure medications SSRIs/SNRIs: Increased risk of serotonin syndrome Dextromethorphan: Potential for increased serotonergic effects
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is closer to the time of the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed dose. If multiple doses are missed, contact healthcare provider for guidance on resumption of therapy.
Overdose
Symptoms may include somnolence, agitation, hyperactivity, abnormal behavior, gastrointestinal symptoms, tachycardia, dizziness, and hypertension. In severe cases, seizures and QT prolongation may occur. There is no specific antidote for atomoxetine overdose. Management should include supportive care with monitoring of cardiac function and vital signs. Gastric lavage may be considered if presented early after ingestion. Activated charcoal may be administered. Dialysis is not likely to be effective due to high protein binding.
Storage
Store at room temperature (20-25°C or 68-77°F) with excursions permitted between 15-30°C (59-86°F). Keep container tightly closed and protect from moisture and light. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Dispose of unused medication through medication take-back programs or according to FDA-recommended disposal methods.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Strattera is a prescription medication that should be used only under the supervision of a qualified healthcare provider. Individual response to medication may vary. Patients should consult their healthcare provider for diagnosis and treatment of medical conditions. Do not start, stop, or change dosage without medical supervision.
Reviews
Clinical trials demonstrate Strattera’s efficacy with 40-60% of patients achieving significant symptom reduction. In a 10-week randomized controlled trial of adults with ADHD, Strattera treatment resulted in mean ADHD-RS score reduction of 37.6% versus 19.6% for placebo (p<0.001). Long-term studies show maintained efficacy for up to 2 years of continuous treatment with stable dosing. Patient-reported outcomes indicate particular benefit for emotional regulation and organizational skills, though gastrointestinal side effects and fatigue are commonly reported during initial titration periods.