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Strattera: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on May 24, 2021.

1. How it works

  • Strattera is a brand (trade) name for atomoxetine. Atomoxetine selectively inhibits the reuptake of norepinephrine (a neurotransmitter).
  • The exact way Strattera works for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) is not known but is thought to be related to an increase in norepinephrine concentrations in the nerve synapse (the space between two nerves).
  • Strattera belongs to the class of medicines known as selective norepinephrine reuptake inhibitors (SNRIs).

2. Upsides

  • Strattera may be used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD).
  • Strattera does not require routine laboratory monitoring, although a doctor may wish to regularly check heart rate and blood pressure and in children, growth rate.
  • The dosage of Strattera does not need adjusting in severe kidney disease.
  • A person's ethnic origin does not affect the duration of action or effect of Strattera (although 7% of Caucasians are poor metabolizers which means they are more likely to suffer side effects from Strattera).
  • Strattera is not a controlled substance.
  • Strattera does not appear to have any stimulant or euphoric properties and is not associated with abuse.
  • Strattera has not been associated with any withdrawal syndrome on discontinuation or symptom rebound. Can be discontinued without tapering.
  • May be taken with or without food.
  • Strattera is available as a generic under the name atomoxetine.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Nausea, vomiting, abdominal pain, decreased appetite, constipation, headache, dry mouth, tiredness, and sleepiness are the most commonly reported side effects.
  • Strattera has been associated with an increased risk of suicidal thoughts or behavior in children and adolescents with ADHD. Talk with your doctor if you notice any worrying change in mood or behavior in a child or adolescent prescribed Strattera.
  • May interact with some medications including monoamine oxidase inhibitors (a type of antidepressant), paroxetine, fluoxetine, and quinidine, blood pressure medications, decongestants, and albuterol.
  • May not be suitable for some people including those with narrow-angle glaucoma, phaeochromocytoma, and severe cardiovascular disorders, heart disease, or with high blood pressure or tachycardia that may be worsened by increases in blood pressure or heart rate.
  • The dosage may need reducing in people with liver disease. 50% of the usual dosage is recommended for people with moderate hepatic impairment (Child-Pugh Class B) and 25% of the usual dosage is recommended for those with severe hepatic impairment (Child-Pugh Class C).
  • A dosage adjustment is also recommended in those taking a strong CYP2D6 inhibitor (such as paroxetine, fluoxetine, or quinidine) or those known to be CYP2D6 poor metabolizers. In children and adolescents under 70kg, start at 0.5mg/kg/day and only increase to the usual target dose of 1.2 mg/kg/day if symptoms do not improve after 4 weeks and the dose is well tolerated. For adults and children weighing >70kg start Strattera at 40 mg/day and only increase to the usual target of 80 mg/day if symptoms fail to improve and the dose is well tolerated.
  • Rarely, severe liver damage has been associated with Strattera. Liver function tests should be ordered if liver damage is suspected (symptoms include widespread itch, dark urine, yellowing of the skin, right upper abdominal pain, or unexplained "flu" like symptoms).
  • Rarely, may cause orthostatic hypotension (a dropping of blood pressure when going from sitting or lying down to a standing position). Has also been associated with other serious heart problems, some of which have been fatal.
  • May precipitate manic or psychotic symptoms, especially in people with undiagnosed bipolar disorder.
  • Rarely, has been associated with urinary problems, priapism (painful erections lasting more than four hours), and allergic events.
  • May affect growth rate in children. Height should be monitored during treatment with Strattera.
  • Only available as a capsule.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

  • Strattera is a medication used for the treatment of ADHD. It is not a controlled substance and appears to have no abuse potential or discontinuation syndrome on withdrawal.

5. Tips

  • May be taken with or without food.
  • Take exactly as prescribed. Strattera is usually taken once or twice a day.
  • Do not open, chew or crush Strattera capsules. Swallow them whole.
  • Strattera may be administered as a single daily dose in the morning or as evenly divided doses in the morning or late afternoon.
  • Strattera is usually initiated at a low dosage which is slowly titrated every three days or so depending on response.
  • Dosages are usually calculated based on weight for children up to 70kg. No matter the age or weight of the child, the total daily dose of Strattera should not exceed 100mg.
  • Strattera is usually administered in addition to other strategies for managing ADHD, including educational, psychological, and social measures.
  • Strattera may affect your thinking skills. Be cautious driving a car or operating machinery until you know how Strattera affects you.
  • Doctors should re-evaluate the need for Strattera periodically. If a doctor decides to discontinue Strattera, it can be done so without tapering off.
  • Talk with your doctor if you feel depressed or are having suicidal thoughts while you are taking Strattera. If you are a caregiver of a child taking Strattera, monitor them for any changes in mood or behavior that are worrying, such as anxiety, agitation, hearing voices, insomnia, panic attacks, restlessness, and irritability.
  • Do not take any other medication, including over-the-counter medication such as decongestants for a cold or flu, without first talking to your doctor or a pharmacist.
  • Tell your doctor if you develop an itch, dark urine, yellowing of the skin, right upper abdominal pain, or unexplained "flu" like symptoms.
  • Do not attempt to open Strattera capsules or touch your eye after handling the capsules as they are an eye irritant. Always wash your hands after touching Strattera capsules. If Strattera inadvertently comes into contact with the eye, flush the eye immediately with water and obtain urgent medical advice.

6. Response and effectiveness

  • Strattera is well absorbed after oral administration and maximal plasma concentrations are reached approximately one to two hours after dosing. Food does not affect the absorption of Strattera. The full effects of Strattera on ADHD symptoms may take several weeks to develop.
  • The dosage of Strattera should be adjusted in people with liver impairment.
  • Some people do not metabolize Strattera as well as others (7% of the Caucasian population and 2% of African Americans are poor metabolizers) which may lead to higher peak concentrations and a longer duration of effect, and a greater potential for side effects. Talk with your doctor if you are experiencing severe side effects with Strattera.
  • The maximum recommended dose in adults and children over 70kg is 100mg. There is no data to support increased effectiveness at higher dosages.

7. Interactions

Medicines that interact with Strattera may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Strattera. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Strattera include:

  • albuterol
  • amiodarone
  • bupropion
  • chlorpheniramine
  • clomipramine
  • anti-anxiety medications such as lorazepam
  • antipsychotics such as haloperidol
  • dobutamine
  • dopamine
  • medications such as CYP2D6 inhibitors (eg, paroxetine, fluoxetine, quinidine) (dosage reduction required)
  • monoamine oxidase inhibitors (MAOIs), such as isocarboxazid, phenelzine, or selegiline (do not take within 2 weeks of discontinuing)
  • selegiline.

Note that this list is not all-inclusive and includes only common medications that may interact with Strattera. You should refer to the prescribing information for Strattera for a complete list of interactions.

References

Strattera [Package Insert]. Revised 02/2020. Eli Lilly and Company. https://www.drugs.com/pro/strattera.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Strattera only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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