Strattera

Note: As of November 2023, drug manufacturer Eli Lilly and Company discontinued all strengths of Strattera from the marketplace. Its generic, atomoxetine, is available.

• What is Strattera?
• Strattera vs. Adderall
• Strattera Dosage Information
• Strattera Side Effects
• Strattera Precautions
• Strattera Interactions

What is Strattera? What Does Strattera Do?

Strattera (Generic Name: atomoxetine) is an alternative to the stimulant ADHD medications most commonly used to treat symptoms of attention deficit hyperactivity disorder (ADHD) in children ages 6-12, adolescents, and adults. It is a selective norepinephrine reuptake inhibitor (SNRI) medicine. Strattera is a non-stimulant; it 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 medication approved for ADHD treatment in the United States by the Food and Drug Administration (FDA) in 2002. It was also the first non-stimulant medication to be approved for treating adults with ADHD.¹

Is Strattera Better Than Adderall?

Strattera and Adderall are both medications used to treat ADHD, but they are fundamentally different. Adderall is a stimulant, and Strattera is a non-stimulant medication. Strattera is the brand name for the drug atomoxetine, which is a norepinephrine reuptake inhibitor that allows the neurotransmitter norepinephrine to be available to the brain’s neurons for longer. Adderall is the brand name for the combination of the drugs dextroamphetamine and amphetamine, and it acts on the central nervous system by boosting the number of dopamine and norepinephrine transmitters in the brain.

Generally speaking, stimulant medications are significantly more effective than Strattera for treating ADHD. Stimulant medications like Adderall are considered first-line medication for treating ADHD, while non-stimulant medications, like Strattera, are considered second-line medications for treating ADHD.²

Strattera is used, however, in special circumstances and patient populations:

• About 15% of people either do not get benefits from or tolerate stimulant medications; for one in seven people, Strattera may be the drug of choice
• Many parents and adult patients find the idea of taking a “stimulant” either frightening or otherwise unacceptable
• Substance use disorders are very common in people who have ADHD. The first-line stimulant medications are considered to be risky with people who have experienced either active or recent uncontrolled drug and alcohol abuse, and Strattera again becomes the drug of choice
• Stimulants should not be used with patients who have co-existing conditions such as untreated glaucoma, structural heart defects, and uncontrolled seizures. Strattera is often used in such circumstances
• Strattera can be additive to other second-line ADHD medications, such as the alpha agonist medications guanfacine and clonidine

In these circumstances, non-stimulant medications like Strattera are an effective alternative.

According to information provided by the drug’s manufacturers, it can take four to eight weeks for Strattera to reach the maximum therapeutic effect. The medication lasts 24 hours. In contrast, the effects of Adderall may be felt as soon as 30 minutes to one hour. The medication lasts for four hours (Adderall) and 12 hours (Adderall XR).

What is the Typical Dosage for Strattera?

The optimal dosage of Strattera varies by patient. For updated information about dosages, interactions, and precautions, see the Strattera drug monograph on WebMD.

The time-release formulation is designed to maintain a steady level of medication in your body throughout the day. Your doctor may adjust your daily dosage after three 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.

As with all medications, follow your Strattera prescription instructions exactly. Strattera is taken orally, with or without food, once or twice daily.

The most common reason why patients don’t experience optimal benefits from Strattera is a high level of side effects, which prevents them from taking a dose high enough to be therapeutic. As a result, it is vitally important that the severity of side effects be lowered by dividing the dose through the day. Although Strattera was studied and approved by the FDA at a frequency of one dose per day, the short duration of the atomoxetine molecule in the body means that people will experience greater effectiveness with fewer and less severe side effects if the dose is divided and taken at least twice a day and sometimes three times a day. 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.

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

During treatment, your doctor should 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.

What Are the Most Common Side Effects of Strattera?

The most common side effects of Strattera are as follows:

Side Effects in Children and Adolescents (Ages 6 – 17):

• upset stomach
• headache
• decreased appetite
• nausea
• vomiting
• somnolence

Side Effects in Adults:

• constipation
• dry mouth
• nausea
• decreased appetite
• insomnia
• dizziness
• sexual side effects
• problems passing urine

Serious Side Effects:

• severe allergic reaction
• 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

Strattera and Familial Mental Health Issues

Disclose to your physician all mental health issues, including any family history of suicide, bipolar illness, or depression. Atomoxetine is a potent trigger for mania in genetically predisposed people. It may not be possible to determine whether a manic or mixed episode that appears during treatment is due to an adverse reaction to the drug or a patient’s underlying bipolar disorder. As a result, the FDA recommends evaluating every patient for past symptoms consistent with a diagnosis of bipolar or a family history of bipolar or cyclic mood disorders prior to administrating 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.

Strattera carries the same black box warning that every antidepressant medication has regarding the risk of inducing suicidal thoughts. Strattera was developed by the same laboratory that discovered Prozac (fluoxetine), but it does not have any detectable benefits for either depression or anxiety disorders. It does have a 0.4% incidence of new suicidal thinking (compared to none in placebo groups) but with no history of people acting on those thoughts. If suicidal thoughts occur, call your clinician to discuss a course of action

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.

Strattera and Liver Problems

Discuss any existing liver problems with your doctor. Strattera has been associated with two cases of severe liver injury since it was approved by the FDA. 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.

Strattera and Heart- or Blood-Pressure Related Problems

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.

If side effects are bothersome, or do not go away, talk to your doctor. 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.

Strattera and Growth

If used for a long time, Strattera may affect a child’s growth rate, weight, and final adult height. To reduce the risk, the doctor may recommend briefly stopping the medication occasionally. Check the child’s weight and height regularly, and consult your doctor or pharmacist for more details.

What Precautions Are Associated with Strattera?

You should not take Strattera if you have:

• taken, or plan to take an antidepressant monoamine oxidase inhibitor or MAOI within 14 days
• untreated narrow-angle glaucoma
• an allergy to atomoxetine or any other ingredients in Strattera
• 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.

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.

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

What Interactions Are Associated with Strattera?

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

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.

More Information on Strattera and Other ADHD Medications:

ADDitude Directory: Find ADHD Specialists and Clinics Near You
Free Download: The Complete Guide to ADHD Medications
A Parent’s Guide to ADHD Medications
How Does ADHD Medication Work? Your First Questions Answered.

Sources:

¹Strattera (atomoxetine hydrochloride) capsules label. Eli Lilly and Company. http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021411s035lbl.pdf

²Clemow, David. Suboptimal Dosing of Strattera (atomoxetine) for ADHD Patients. Postgraduate Medicine (Mar. 2015) https://www.tandfonline.com/doi/abs/10.3810/pgm.2014.09.2814

³Farone, Stephen. Adderall XR vs. Strattera in School-Aged Children: 3 Month Projected Outcomes. Guildford Journals (2007). https://guilfordjournals.com/doi/pdf/10.1521/adhd.2007.15.5.14