Highlighting uses, dosage, how to take & discontinue, side effects, pros & cons, and more

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Brand & Generic Names; Drug Classes

US brand name: Strattera
Generic name: atomoxetine

Drug Class(es)

Primary drug class: Antidepressants
Additional drug class(es): Norepinephrine-Selective Reuptake Inhibiting Antidepressants non-stimulant treatment for ADD

Approved & Off-Label Uses (Indications)

Strattera’s US FDA Approved Treatment(s)

ADD/ADHD for adults and children

Uses Approved Overseas but not in the US

Off-Label Uses of Strattera

  • Depression
  • Panic/anxiety
  • Bipolar depression

When & If Strattera Will Work

Strattera’s Usual Onset of Action (when it starts working)

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. Return to Table of Contents

Likelihood of Working

Return to Table of Contents

Taking and Discontinuing

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 mg to 25 mg once daily. Got that? 18–25 mg. Not 40 mg. Not 60 mg. 18–25 mg.

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. Return to Table of Contents

How to Stop Taking Strattera (discontinuation / withdrawal)

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. Return to Table of Contents

Strattera’s Pros and Cons

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. Return to Table of Contents

Cons

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.) Return to Table of Contents

Interesting Stuff your Doctor Probably didn’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. 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. Return to Table of Contents

Best Known for

Return to Table of Contents




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Strattera’s Potential Side Effects

Potential Side Effects All Crazy Meds Have

No matter which neurological and/or psychiatric drug you take, you’ll probably get one or more of these side effects. These will usually be gone, or at least will diminish to the point where you barely notice it most of the time, within a week or two.

  • Headache
  • Drowsiness / fatigue - even when taking stimulants in some circumstances.
  • Insomnia, instead of or alternating with the drowsiness.
  • Nausea
  • Assorted other minor GI complaints (constipation, diarrhea, etc.)
  • Generally feeling spacey / out of it
    • Which can all add up to the ever-helpful “flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.1
  • All crazy meds can, and probably will affect your dreams as well. There is no way of telling if that will be good or bad, let alone if this side effect is permanent or temporary.
  • Any of the above side effects you see listed again below means they’re even more likely to happen and/or stick around longer and/or are worse than most other meds.

Typical Potential 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. If you have a job that requires you to be at work in the morning, consider it a feature and not a bug. Return to Table of Contents

Uncommon Potential 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) 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. Return to Table of Contents

Freaky Rare Side Effects

NSRIs are well known for having few side effects at all, let alone freaky rare ones. One guy had bloody sperm and someone else developed salivary duct stones. That’s it. Return to Table of Contents

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What You Really Need to be Careful About

Strattera can make your liver explode. Why Lilly has an implied “It’s OK to drink” in the interactions section of the PI sheet and no “don’t mix booze and Strattera” warning is beyond me. Did they forget that adults take it?

Return to Table of Contents

Pregnancy Category

C-Use with caution Return to Table of Contents

Pharmacology

Strattera’s Half-Life & How Long Until It Clears Your System

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. Plasma Clearance is one to five days.

Steady State

Steady state is reached in 36 to 48 hours.

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 bloodstream2, 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 what3, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.

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.

Return to Table of Contents

How atomoxetine Works

the current best guess at any rate
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 atomoxetine does most of this in your frontal and prefrontal cortices, Strattera 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.

Atomoxetine has an active metabolite, 4-hydroxyatomoxetine. It’s apparently as potent as atomoxetine, but as you get only the equivalent of 1 mg per 100 mg of atomoxetine, it doesn’t really do all that much. Return to Table of Contents

Active Ingredient

atomoxetine hydrochloride


The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.

Return to Table of Contents

Shelf Life

3 Years Return to Table of Contents

Strattera’s Noted Drug-Drug, Drug-Food & Drug-Supplement Interactions

  • Albuterol. The kids with ADD and asthma can’t catch a break. This is a pharmacodynamic (how meds work) interaction, and applies to all beta2 agonists, as Strattera can increase the effects of Albuterol. Depending on when the Strattera was taken. And it doesn’t happen with everyone.
  • Anything that inhibits or induces CYP2D6, such as:

Return to Table of Contents

Check for Other Drug-Drug, Drug-Food & Drug-Supplement Interactions Strattera may have at

Drugs.com’s drug-drug and drug-food interaction checker

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 teh Faecesbooks.
Learn more about drug-everything interactions on our page of tips about taking crazy meds.



Name, Address, Serial Number (Generic and Overseas Availability)

Available in the US as a generic? Yes

Other Trade Names and Overseas Availability

Not including controlled/extended/sustained release suffixes (Efexor ER, Trevilor retard e.g.) or branded generics that are a hyphenate of the generic name and the drug company name (Apo-Citalopram e.g.).

Return to Table of Contents

Shapes & Sizes (How Supplied)

  • 10 mg white capsules
  • 18 mg gold and white capsules
  • 25 mg blue and white capsules
  • 40 mg blue capsules
  • 60 mg blue and gold capsules
  • 80 mg brown and white capsules
  • 100 mg brown capsules
Strattera capsules 10 to 60 mg
Strattera capsules. Top to bottom: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg

Return to Table of Contents

Comments, PI Sheet, Ratings, Reviews and More

Comments

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.


Return to Table of Contents

Rate Strattera

Give your overall impression of Strattera on a scale of 0 to 5.

Get all critical about Strattera

3.5 stars Rating 3.5 out of 5 from 172 criticisms.
Vote Distribution: 21 – 4 – 15 – 12 – 72 – 48


Rate this article

If you’re still feeling judgmental as well as just mental4, 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

4.5 stars Rates 4.2 out of 5 from 216 value judgments.
Vote Distribution: 15 – 1 – 4 – 12 – 58 – 126


Return to Table of Contents

Pages and Forum Topics Google Thinks are Relevant to Your Mental Health

Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest

Discussion board

If you have any questions not answered here, please see the Crazymeds Strattera discussion board. Return to Table of Contents


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References

  1. Full US PI Sheet
  2. Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton
  3. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series)
  4. PDR: Physicians’ Desk Reference 2010 64th edition

Return to Table of Contents


1 As well as being an indication of half of said conditions.

2 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 state if they can't get, or won't provide a number for that.

3 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.

4 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. We 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 we write these damn things. 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. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)


Last modified on Wednesday, 04 May, 2016 at 17:56:12 by JerodPoorePage Author Date created
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Strattera, and all other drug names on this page and used throughout the site, are a trademark of someone else. Strattera’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




Page design and explanatory material by Jerod Poore, copyright © 2003 - 2016. All rights reserved.
Keep up with Crazymeds and and/or my slow descent into irreparable madness boring life. Pick your preferred social media target(s):

Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016 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.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
Crazymeds now uses a secure server, but it is not so secure that you can discuss anything having to do with nuclear power facilities, air traffic control systems, aircraft navigation systems, weapons control systems, or any other system requiring failsafe operation whose failure could lead to injury, death or environmental damage. Just so you know. So if you’re mentally interesting and have a job that deals with that sort of thing, talk about said job elsewhere. Otherwise feel free to discuss your meds and brain cooties.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘Everything is true, nothing is permitted.’ - Jerod Poore


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?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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