Strattera vs Adderall: What is the difference?
Medically reviewed by Drugs.com. Last updated on Aug 29, 2019.
Strattera and Adderall are both used in the treatment of ADHD. Is one more effective or more likely to cause dependence than the other?
Strattera contains atomoxetine whereas Adderall contains a mixture of amphetamine salts (MAS). Both Strattera and Adderall are effective for ADHD; however, Strattera is not a stimulant which means it is not likely to be abused or cause dependence, tolerance, or withdrawal symptoms on discontinuation.
- Strattera may be better tolerated than Adderall and its main side effects include drowsiness and mild appetite suppression.
- Both may affect the heart and slow growth rate in children, Adderall probably to a greater extent.
- Strattera is more expensive than Adderall and may increase the risk of thoughts of suicide in children and adolescents.
What is Atomoxetine?
Atomoxetine (Strattera) is a man-made selective norepinephrine reuptake inhibitor medicine, that increases the amount of norepinephrine in the brain, although the exact way it works in ADHD is unknown. Strattera was first approved in 2002 and represented a new class of treatment that worked differently from the other ADHD treatments available at the time. Strattera is not a stimulant.
What is in Adderall?
The MAS contained in Adderall are dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate; often abbreviated to 75% dextroamphetamine + 25% levoamphetamine. Adderall is also a man-made stimulant and was first approved in 1996 and is thought to work in ADHD by increasing the concentration of two neurotransmitters (dopamine and norepinephrine) in the brain. Both Strattera and Adderall are approved to treat ADHD, although Adderall is also approved to treat narcolepsy.
Strattera is a noncontrolled substance, and studies have identified only isolated incidents of inappropriate self-administration, meaning it lacks the abuse potential and dependence risk seen with stimulant-type drugs such as Adderall. There is also no evidence of symptom rebound or withdrawal symptoms on drug discontinuation. Strattera may be useful in patients with ADHD and a comorbid substance abuse disorder or tic disorder.
Conversely, Adderall is classified as “Schedule II” controlled-substance. It is not uncommon for people who have taken Adderall for extended periods of time to become psychologically dependent on it. Tolerance may also develop - this when an increasing dose is needed in order to achieve the same reduction in symptoms. Adderall has also been associated with withdrawal symptoms on discontinuation. Therefore Adderall is much more likely to be abused than Strattera, and this represents a significant difference between the two drugs. For more information on the dangers of Adderall being used as a study aid or "smart pill" see Adderall for study: Does it really make you smarter?
Strattera is not recommended for children aged younger than six, and Adderall is not recommended for children younger than three. Strattera has a black box warning (serious) regarding its association with a greater risk of suicidal ideation in children and adolescents with ADHD (risk identified as 0.4% with Strattera compared with 0% with placebo [a pretend pill]). Anyone who is started on Strattera should be monitored closely for suicidal thinking and behavior or unusual changes in behavior, and their doctor contacted urgently if any changes are noted. Both Adderall and Strattera have cardiovascular effects and can increase heart rate and blood pressure. Adderall has a black box warning regarding its potential for abuse and risk of cardiac events including sudden death after misuse.
Studies have shown that both Strattera and Adderall are more effective in ADHD than a placebo (pretend) tablet but there is a lack of trials directly comparing the two drugs, which makes it difficult to compare the potencies of each drug on a mg for mg basis. 62 children unable to tolerate MAS or methylphenidate or with an incomplete response to either were switched to atomoxetine in one trial. Almost 66% preferred atomoxetine to their previous psychostimulant and the majority showed an improvement in ADHD symptom severity.
The most common side effects reported in this trial for atomoxetine were drowsiness, fatigue, decreased appetite, cough, headache and contact dermatitis. Other common side effects of Strattera include nausea, vomiting, an upset stomach, constipation, dry mouth, and erectile dysfunction. Common side effects of Adderall include dizziness, insomnia, nervousness, stomach aches and a decrease in appetite leading to weight loss. In addition, Adderall may also cause diarrhea, dry mouth, fever, headache, irritability, nausea, and vomiting. Although studies have shown that both drugs can cause a slowing in the growth rate of children, Adderall appears to have a more significant effect than Strattera. All children should be monitored during treatment and a different treatment considered if there is a substantial deviation from their anticipated growth trajectory. Side effects of both drugs are more likely at higher dosages.
Most trials investigating the effectiveness of medications in ADHD have found that not everybody responds equally to all medications, in fact, around 15% of participants tend to respond more favorably to one medication over another. This means that if one treatment is ineffective or intolerable it is appropriate to try another treatment. Behavioral therapy is still recommended as the first treatment to try before medication in young children with ADHD.
Formulations and Cost
Strattera has a long duration of effect which means it can be taken once a day, or if preferred, as a split dose twice a day (morning and late afternoon/early evening), either with or without food. Strattera is available as seven dosages (10mg, 18mg, 25mg,40mg,60mg, 80mg, 100mg). Strattera capsules should not be crushed, chewed, broken or opened. The recommended target daily dose of Strattera is 80mg/day (cost approximately $466 for 30 capsules of 80mg). There is currently no generic for Strattera; however, the patent expires in 2017.
Immediate-release (IR) forms of Adderall have a duration of effect of 4 to 6 hours, but extended-release forms are also available (Adderall XR) that provide a sustained psychostimulant effect for up to 12 hours. Adderall IR is also available in seven different dosages (5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg) and Adderall XR six different dosage forms (5mg,10mg, 15mg, 20mg, 25mg, 30mg). Target does of Adderall XR range between 20mg/day to 40mg/day (cost approximately $172 for 30 capsules of 20mg). Adderall XR capsules should not be chewed or crushed; however, the capsules may be opened and the contents sprinkled on applesauce and swallowed straight away. Adderall is available as a generic.
Studies have shown that individual responses to ADHD medications vary, and up to 15% of people will respond to one drug but not to another. Therefore it is worthwhile trying a different type of ADHD medication if one treatment is found to be ineffective.
- Adderall (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate) [package insert]. Revised 12/2015. Teva Select Brands. https://www.drugs.com/pro/adderall.html
- Strattera (atomoxetine HCL). CenterWatch. http://www.centerwatch.com/drug-information/fda-approved-drugs/drug/813/strattera-atomoxetine-hcl
- Strattera (atomoxetine HCL) [Package Insert] Drugs.com. Eli Lilly and Company. Revised 06/2015. https://www.drugs.com/pro/strattera.html
- Quintana H1, Cherlin EA, Duesenberg DA, et al. Transition from methylphenidate or amphetamine to atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder--a preliminary tolerability and efficacy study. Clin Ther. 2007 Jun;29(6):1168-77.
- Vitiello B. Understanding the Risk of Using Medications for ADHD with Respect to Physical Growth and Cardiovascular Function. Child and adolescent psychiatric clinics of North America. 2008;17(2):459-xi. doi:10.1016/j.chc.2007.11.010.
- Budur K, Mathews M, Adetunji B, Mathews M, Mahmud J. Non-Stimulant Treatment for Attention Deficit Hyperactivity Disorder. Psychiatry (Edgmont). 2005;2(7):44-48.
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