Strattera (Straterra, Stratera)

One of the ways that I learn about what readers seem to like is by looking at my "referrer logs."

Most of the traffic that comes to this site is coming from search engines.  Google is clearly #1. 

(I recently discovered froogle.  It's for buying stuff … seems to work pretty well).

The most commonly searched-for item since November is Strattera (sometimes incorrectly spelled Stratera or Straterra in the search engine queries  The correct spelling is with TWO t's and ONE r).  I wrote a quick note on this medication last fall.  Since many people seem to be looking for information in it, I'll provide a little more insight into Strattera.

Atomoxetine (Straterra) is a nonstimulant treatment for ADD/ADHD.  It's the first medication that is indicated for the treatment of ADD/ADHD in children and adults.

Mechanism of action

A selective inhibitor of norepinephrine reuptake. 

Indications

Indicated for the treatment of attention-deficit/hyperactivity disorder in patients six years of age and older.

Dosage Forms

It's available as capsules in 10 mg, 18 mg, 25 mg, 40 mg, and 60 mg strengths.

Dosage

For children and adolescents weighing up to 70 kg, the initial dose should be 0.5 mg/kg per day. 

After at least three days it can be increased to a target daily dose of 1.2 mg/kg per day in one or two daily doses.  The maximal daily dose for these patients is 1.4 mg/kg.

For children and adolescents over 70 kg and adults, the initial dose is 40 mg per day.  This can be increased after a minimum of three days to a target dose of approximately 80 mg either as a single dose in the morning, or in two evenly divided doses.  After anther two to four weeks it can be increased to a maximal dose of 100 mg per day for those who have not achieved an optimal response.

Here's a little table that I made that may help with Strattera dosing:

Pounds Kilos Initial Daily Dosage (mg) Target Daily Dosage (mg) Dosage in 10 mg, 18 mg, 25 mg, 40 mg, and 60 mg strengths.
60 27 14 33 18 mg 1 QD x 1 week then titirate up. Could use 25 mg QD then 18 Bid
70 32 16 38 18 mg 1 QD x 1 week then titirate up. Could use 25 mg QD then 18 Bid
80 36 18 44 18 mg x 1 week then titirate up. Could use 25 mg QD then 40 mg QD
100 45 23 55 25 mg x 1 week then titirate up. Could use 40 mg QD then 60 mg QD
120 55 27 65 25 mg x 1 week then titirate up. Could use 40 mg QD then 60 mg QD
140 64 32 76 25 mg x 1 week then titirate up. Could use 40 mg QD then 60 mg QD
160 73 36 87 40 mg x 1 week then titirate up. Could use 60 mg QD then 40 mg BID (or Two 40 MG tabs QD)
180 82 41 98 40 mg x 1 week then titirate up. Could use 60 mg QD then 40 mg BID (or Two 40 MG tabs QD)
200 91 45 109 40 mg x 1 week then titirate up. Could use 60 mg QD then 40 mg BID (or One 40 mg & One 60 mg QD)
 
Maximum – 100 mg/day

Elimination

Hepatic metabolism primarily by CYP 2D6.  Patients taking inhibitors of this enzyme (paroxetine, fluoxetine, or quinidine) should have the dose adjusted.  The initial dose is 0.5 mg/kg daily for children and adolescents up to 70 kg, but the dose should only be increased to 1.2 mg/kg daily if symptoms fail to improve after four weeks and the initial dose is tolerated.  For children and adolescents over 70 kg and adults, the initial dose of 40 mg should only be increased to 80 mg if symptoms fail to improve after four weeks of treatment and it is well tolerated.

Administration

Can be given with or without food.  Should be reduced to 50% of suggested for those with moderate hepatic insufficiency, and to 25% for those with severe hepatic insufficiency.  Can be discontinued without tapering.

Adverse Effects

The most common adverse effects observed in clinical trials included dyspepsia, nausea, vomiting, fatigue, decreased appetite, dizziness, and mood swings.  Increases in blood pressure and heart rate have been observed.  MIld weight loss and slowing of growth have been observed, and patients should be monitored. 

Drug Interactions

Should not be used with MAO inhibitors.  Inhibitors of CYP 2D6 can increase the serum concentrations of atomoxetine.  Common examples include paroxetine, fluoxetine, and quinidine.  Atomoxetine does not significantly interact with CYP 1A2, CYP 3A, CYP 2D6, or CYP 2C9.  It should be used with caution with other drugs that can increase heart rate or blood pressure.

Contraindications

Hypersensitivity, concurrent use of MAO inhibitors, and narrow angle glaucoma.

Precautions

Should be used cautiously in patients with hypertension, tachycardia, or other cardiovascular conditions.  It may also increase the risk of urinary retention and should be used cautiously in patients at risk for this.

Use In Pregnancy

Pregnancy Category C.