Strattera (atomoxetine HCl)

US Brand Name: Strattera

generic name: atomoxetine HCl

Class: Norepinephrine-Selective Reuptake Inhibiting Antidepressants Technically Strattera is a non-stimulant treatment for ADD. Chemically it’s an antidepressant.

1.  FDA Approved Uses of Strattera

ADD/ADHD for adults and children

2.  Off-Label Uses of Strattera

• Depression
• Panic/anxiety
• Bipolar depression

3.  Strattera’s pros and cons

3.1  Pros

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.

3.2  Cons

Tends to poop-out rapidly for some. 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 HCl) won’t trigger a mania, it will aggravate existing cycling, it’s a fine distinction.)

4.  Strattera’s Side Effects

4.1  Typical Side Effects

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.

4.2  Not So Common Side Effects

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.

4.3  Freaky Rare Side Effects

NSRIs are notorious for having few side effects at all, let alone freaky rare one. One guy had bloody sperm and someone else developed salivary duct stones.

5.  Interesting Stuff Your Doctor Probably Won’t Tell You about Strattera

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.

6.  Strattera’s Dosage and How to Take Strattera

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.

7.  How Long Strattera Takes to Work

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.

8.  How to Stop Taking Strattera

Your doctor should be recommending that you reduce your dosage by 20mg a day every 3–4 days if you need to stop taking it, if not more slowly than that. 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.

9.  Strattera’s Half-Life & Average Time to Clear Out of Your System

Strattera (atomoxetine HCl) 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.

10.  Days to Reach a Steady State

As the active portion of Strattera 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.

11.  How Strattera Works

Based upon the chemical imbalance theory of mental illness (or brain cooties as we often call it), Strattera 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.

12.  Comments

13.  Discussion board

Crazy Meds’ Strattera discussion board

14.  Your Comments About and Experiences with Strattera

Tell us what you think about Strattera

I’m currently taking:

Effexor XR 225mg Lamotrigine 400 mg Remeron 45mg Klonopin 2 mg

My doc started me on Strattera two days ago. I am having trouble finishing up some papers for school and I asked for something to help me focus, even tho I am not ADHD, or at least never been diagnosed that. I have several diagnoses, but let’s just say I’ve got generalized anxiety/depression.

I had a strange effect after my first dose. The next day (yesterday), after my second dose, I was really freaked out - confusion, anxiety, edgy, irritable. I suspected, given what I’m already taking, that I might have mild seratonin syndrome.

It was pretty bad, I had to call a neighbor to come get my kids, I couldn’t stop yelling at them and slamming doors. To make it worse, I can’t get hold of my doc.

To let you know, this is a new pdoc and he’s been really liberal with the meds. He gives me whatever I ask for (good thing I’m not a junkie). Thing is, I don’t think he thinks about the consequences - like how it might interact.

I’m so lame. I have nobody else to turn to, so I’m posting here. Any advice, thoughts, would be appreciated. Thanks.

Eugenia (no signature yet)

Because I can’t figure out how to edit my last post, allow me to add that the dose of strattera was a pithy 10 mg.

Eugeniajp,

  This may be very important I have a BPII + ADD dual diagnosis, and I don’t tolerate stimulants very well.  My doc considered Strattera, but first I had to undergo an ECG to detect a cardiac rhythm abnormality called Atrial-Ventricular block.  It sounds more serious than it is under ordinary circumstances.  You can go through life normally with a moderate AV block.  It poses no danger, doesn’t get worse by itself, and doesn’t limit your activities noticeably.  But Strattera does something to people with AV block that can cause them to drop dead.  No, I’m not exaggerating.  I thought my doc was, when she told me about it, but drop dead was the term she used to get it into my head.  Since I had the block, which nobody knew about before the ECG, Strattera was absolutely ruled out.  Take home this: absolutely do not take  before you have an ECG done to rule out  anyabnormality in your heart’s rhythm.
  The PI sheet makes it sound like “sudden death” is a danger in folks with cardiac arhythmias and other more obvious heart problems.  They don’t mention AV block.  Perhaps sudden death from AV block wasn’t known at the time.
  Hopefully, your pdoc has considered this, but you didn’t mention it and it doesn’t seem that you have full confidence in him/her.  I apologize for my alarmism, but I am concerned.

  Regarding serotonin syndrome, your symptoms don’t sound like it to me.  I had SS once, and the symptoms were a sweaty, clammy feeling all over with chills, muscle aches, slight nausea - like I was coming down with the flu.  Read the warnings on the PI sheet and you will see that manic symptoms including irritability and aggressiveness can result from Strattera use.

Best of Luck, Mark

I was diagnosed with ADHD almost two ago. It definitely made a lot of sense once I understood what it is. I started taking Strattera because my doc thought it would help not only with the ADHD but, maybe also with some depression I had from time to time (including suicidal pms). She started me on 18 mg and I wasn’t sure if it was helping so she upped it to 40 a few weeks later and then it was like having the curtains lifted. Amazing how much better I was able to function in life and get things done. Previously I would more often than not go through a whole day and then wonder what I did with the time. After being on it I was able to keep lists AND complete the tasks on them. I was able to remember AND be on time for appointments. I was able to forsee the consequences of my actions beforehand. It was great. There were some side affects and I will discuss those too for people who are curious. First I had a feeling of euphoria (atleast that is what my doctor hubby said it was) It was like even the smallest thing gave me a physical rush just like I was on a first date or had had amazing sex but, that didn’t last for more than a week or so. Plus, it was kind of wierd to be feeling like that all the time. The much more troubling side affects were cotton mouth and insomnia. These lasted a little over 2 weeks then the insomnia went away completely and the cotton mouth definitely decreased to a tolerable level…I figured I probably could stand to drink more water anyways. :-) So, all in all my experience with strattera was really positive as it did do alot to help my symptoms and I think it helped me to understand how non-adhd people think and funtion in life as I started to think more like that. Also, it did help to regulate my emotions and the trouble I had had with recurring bouts of depression seemed to have gone away as well. The only reason I weaned off of it was because we wanted a second baby. I was really nervous about it and it has been hard. The plan is to get back on it after the baby is weaned which will be awhile since I still have 8 weeks til her due date! But, my only concern is about long term affects. I guess I’m thinking….I’m only 28 and if I stay on this drug for the rest of my life we could be talking another 50 years…give or take…and what kind of negative effects come from being on a med so long? Or am I wrong in thinking I would just stay on it forever? Would I eventually have to up the dose to see continued effect? Would it hurt my liver over time? I obviously don’t know alot about this and perhaps my ignorance is fueling my concern but, these are the things I’m wondering about. So, if anyone has insight on this I would appreciate a comment. Thanks!

Enter your own Comments & Experiences with Strattera here.
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19.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Strattera Full US Prescribing Information / PI Sheet
Canadian Product Monograph

Check for drug-drug interactions

20.  Bibliography

Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton

Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series)

PDR: Physicians’ Desk Reference 2010 64th edition

Date created 16 Mar 2011 - 16:51 Page Creator: JerodPoore Last edited by:

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