side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
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Table of Contents (hide)
- 1. FDA Approved Uses of Strattera (atomoxetine)
- 2. Off-Label Uses of Strattera (atomoxetine)
- 3. Strattera’s pros and cons
- 4. Strattera (atomoxetine) Side Effects
- 5. Interesting Stuff Your Doctor Probably Won’t Tell You about Strattera (atomoxetine)
- 6. Strattera’s Dosage and How to Take Strattera (atomoxetine)
- 7. How Long Strattera (atomoxetine) Takes to Work
- 8. How to Stop Taking Strattera (atomoxetine)
- 9. Strattera (atomoxetine) Half-Life & Average Time to Clear Out of Your System
- 10. Days to Reach a Steady State
- 11. Shelf Life
- 12. How Strattera Works
- 13. Comments
- 14. Strattera Ratings, Reviews, & Other Sites of Interest
- 15. Bibliography
|US brand name: Strattera|
|Generic name: atomoxetine|
Class: Norepinephrine-Selective Reuptake Inhibiting Antidepressants Technically Strattera is a non-stimulant treatment for ADD. Chemically it’s an antidepressant.
ADD/ADHD for adults and children
- Bipolar depression
When it works, it really works! Far less likely to trigger mania in the bipolar or seizures in the epileptic than most antidepressants. Either is still possible, it’s just that the odds are higher (i.e. the events are less likely). In adults at least. With a low side effect profile for most people, this drug proves to be either ineffectual or just the greatest thing ever for someone.
Tends to poop-out rapidly for some people, especially if they increase their dosage (titrate) too fast. Approved only for ADD/ADHD so doctors won’t prescribe it or insurance plans won’t cover it for depression or bipolar. Doctors frequently screw up the titration. If you’re bipolar and you haven’t stabilized it can aggravate your cycling. (This doesn’t contradict the above. While Strattera (atomoxetine) is much less likely to trigger mania than an SSRI, it’s practically guaranteed to make bipolar cycling a lot worse if you start taking it while you’re cycling. it’s a fine distinction.)
The usual for anything that does norepinephrine-selective reuptake inhibition - headache, dry mouth, urinary hesitance, constipation, somnolence (wanting to sleep all the time) and/or early awakening. For most people the headache tends to go away and will only reappear, if at all, with a dosage increase. The urinary hesitance, constipation, and dry mouth can go away or stay forever. The somnolence/fatigue/constantly being tired is dosage-dependent and often an indicator that you’re taking too much. Early awakening can be constant or strike at random throughout the time you take it. If you have a job that requires you to be at work in the morning, consider it a feature and not a bug.
Nausea (taking it with food usually helps), farting (pull my finger Beavis), higher or lower blood pressure, weight loss regardless of appetite change. Some women will bleed like a stuck pig when it’s that time of the month. Oh, yeah, and there’s that wonderful feeling of euphoria. That can last for months. But Strattera (atomoxetine HCl) isn’t a party drug, kids. You can’t just take it before a rave, it takes days of being on the correct dosage to get that effect, which may or may not happen. One buzzkill for guys could be a variety of sexual dysfunctions ranging from pain during or immediately after ejaculation (although for a small segment of the population that could be a bonus) to not being able to get it up with a forklift. Sometimes these these side effects are temporary, sometimes they aren’t.
Everyone is freaking out about serious liver problems that a handful of people developed. Don’t mix Strattera with alcohol or a history of liver problems, and talk to your doctor about getting periodic liver function and complete blood panels.
Taking Strattera with food interferes with how well Strattera is absorbed. It’s probably not enough to make a difference, but you never can tell. As Strattera will often give people nausea that ranges from mild to severe, and taking medications with food usually prevents that sort of thing, you’ll sure as hell absorb a lot more taking your Strattera with food and keeping it all down than if you take it on an empty stomach and spench it up ten minutes later.
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This med can work wonders for more people if they and their doctors would just have some goddamn patience!!! The initial dosage is 18–25 mg. Got that? 18–25mg. Not 40mg. Not 60mg. 18–25mg.
Unfortunately some bean counter in the bowels of Eli Lilly’s accounting department determined that it was more profitable to restrict the size and number of 18mg and 25mg sample packs (only four capsules in each now), and let some people just fail with this med. So most of the sample packs sent out now are only 40mg capsules. It’s more profitable for Lilly if Strattera doesn’t work for everyone it could work for!! Isn’t that crazy? Anyway, the highest an adult should start at is 25mg a day and just stay there for at least two weeks. Wait at least that long before going up to 40mg, and then only if it’s going to make a big difference, not a small difference.
Once you get past the 25mg a day barrier, dosages are as follows: 36–40 mg a day, 50 mg a day, 60 mg a day, 80 mg a day, 100 mg a day. Doses are usually divided between morning and afternoon, but some people get drowsy with Strattera, while others get hyper, so the dosing can be really flexible.
3–4 days. Unless you absolutely cannot deal with the side effects, you should give it at least one week before raising the dosage and two weeks giving up.
Your doctor should be recommending that you reduce your dosage by 20–40mg a day every 3–4 days if you need to stop taking it. Based on the 13 hour half-life. There’s really nothing in the way of a discontinuation syndrome. Suddenly stopping can result in a nasty rebound of symptoms, or the short-lived mania that sometimes accompanies the discontinuation of an antidepressant, but that’s about it.
Strattera (atomoxetine) does one of those weird double metabolisms. Atomoxetine itself has a mean average half-life of five hours, with poor metabolizers (7% of the Caucasian population, 2% of the African American population in Lilly’s trials) taking up to 24 hours to process it. Then the metabolite is further metabolized into yet another substance, and that has a mean average half-life of 6–8 hours, with the poor metabolizers taking 34–40 hours to deal with it. While Lilly has the resources to tell a poor metabolizer from a regular person, you and your doctor may not. There is a lab test for CYP2D6 efficiency, according to the Strattera (atomoxetine HCl) PI sheet, but your doctor may have to contact Eli Lilly to find out just what it is and how to order it. And how much it costs.
Presume a total half-life of 13 hours and that it’s out of your system in 3–4 days.
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream1, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.
As the active portion of atomoxetine has a half-life in people with normal metabolisms of 6 to 8 hours, and as most people take it once a day, you may or may not reach a steady state in 36 to 48 hours. Eli Lilly didn’t provide any steady state data.
Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.
Based upon the Communications Interference Hypothesis of psychiatric and neurological conditions (or brain cooties as we often call them), atomoxetine effectively raises the norepinephrine levels in your brain by letting your synapses soak in norepinephrine for longer than usual by slowing (inhibiting) the mechanism of norepinephrine transmission deeper into the neurons (reuptake). An increase in norepinephrine can often result in a similar increase in dopamine. Because Strattera does most of this in your frontal and prefrontal cortices it works better as an ADD/ADHD med than an antidepressant, in that there is a shitload more money in treating ADD/ADHD with a drug that is not a stimulant than as an antidepressant for people who would get similar results from Wellbutrin or a TCA.
The other reason why Strattera is an ADD/ADHD med instead of an antidepressant is people with MDD who respond to a drug that is a norepinephrine-selective reuptake inhibitor (NSRI) make up something like 10–15% of the depressed population. At most. So in clinical trials that don’t target people with depression symptoms specific to norepinephrine issues Strattera will (and did) bomb and not be the bomb.
Regardless of why you’re taking it, I can’t stress the importance of a slow titration and staying at a dosage that works instead of ramping up to a target dosage. Like SSRIs, Strattera can frequently and suddenly stop working (poops out), but if you’re taking 80mg (or more) a day within two weeks of starting, you’re just asking for it to poop out on you. Lowering the dosage might help, but there’s no guarantee it will work as well as it used to, if at all.
I miss taking Strattera. I miss getting up at 5:00 a.m. (No, really, I actually like getting up early in the morning) ready to deal with the day. I miss how Strattera and Provigil worked so well together to regulate my sleep, keep me focused in the day time, and were the only really effective antidepressant combination, along with Risperdal, until the nowhere-near-as-good Vivactil & Lamictal cocktail I’m on now.
My brain liked it. My liver hated it.
For years Strattera (atomoxetine) was available only in the US. It is now available in Australia, Canada, Ireland, New Zealand and the UK.
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Get all critical about Strattera
Rating 3.5 out of 5 from 62 criticisms.
Vote Distribution: 7 – 2 – 3 – 6 – 26 – 18
If you’re still feeling judgmental as well as just mental3, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.
Get all judgmental about the Strattera (atomoxetine) Synopsis
Rating 4.3 out of 5 from 97 value judgments.
Vote Distribution: 6 – 1 – 3 – 3 – 23 – 61
14.3 Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, check for drug-drug interactions
- Canadian Product Monograph
- Irish Strattera SPC
- New Zealand Strattera Medicine Data Sheet
- UK Strattera SPC
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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PDR: Physicians’ Desk Reference 2010 64th edition
1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.
2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
3 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
If you have any questions not answered here, please see the Crazymeds Strattera discussion board. I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.
|Last modified on Friday, 28 March, 2014 at 06:35:24 by SomeMedCritic||Page Author: JerodPoore||Date created Wednesday, 16 March, 2011 at 16:51:09|
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]