Attention Deficit Hyperactivity Disorder (ADHD): Nonstimulant Therapy (Strattera) & Other ADHD Drugs
- Nonstimulant therapy
- How does Strattera work?
- Who should not take Strattera®?
- What are the side effects of Strattera?
- Strattera: Tips and precautions
- Antidepressant therapy
- How do antidepressants work?
- Who should not take antidepressants?
- Side effects of antidepressants
- Antidepressants therapy: Tips and precautions
- Other nonstimulant therapies used to treat ADHD
- How do these drugs treat ADHD?
- Who should not take these drugs?
- What are the side effects of these drugs?
- Other nonstimulant medications: Tips and precautions
- Strattera Side Effects
- What it’s like to live with ADHD so severe it feels like ‘brain fog’
- Defining ADHD
- Engaging with the world when you can’t focus
- Variation between cases
- When treatments don’t work
- Navigating a world that doesn’t accommodate your symptoms
- What is Strattera?
- What is the Typical Dosage for Strattera?
- What Are the Most Common Side Effects Associated with Strattera?
- Other Precautions and Interactions Associated with Strattera
Attention Deficit Hyperactivity Disorder (ADHD): Nonstimulant Therapy (Strattera) & Other ADHD Drugs
There are many drugs other than psychostimulants that can be used to treat ADHD.
Strattera® (atomoxetine) is the first nonstimulant approved by FDA for the treatment of ADHD. Strattera and all the other nonstimulants are generally considered to be less effective than psychostimulants in the treatment of ADHD. The nonstimulants are usually considered second- and third-line medications.
Strattera works on the neurotransmitter (chemical in the brain that transmits nerve impulses) called norepinephrine. Like the stimulant drugs, Strattera is effective in treating and controlling ADHD symptoms. Unlike stimulant drugs, Strattera is not a controlled substance. Therefore, people are less likely to abuse or become dependent on it.
In addition, Strattera does not cause many of the potential side effects linked to psychostimulants, such as sleeplessness. Strattera can cause very significant abdominal pain, nausea, and drowsiness, especially when starting the medication. Strattera tends to offset the effect of the stimulant starting to work and then wearing off. At times, it still needs to be taken more than once a day.
How does Strattera work?
This medication works by increasing the amount of norepinephrine, an important chemical in the brain. Doing this appears to help ADHD by increasing attention span and reducing impulsive behavior and hyperactivity.
Who should not take Strattera®?
There are certain situations in which a person should not take Strattera. If you or your child has any of the following conditions, you should inform your healthcare provider before taking Strattera:
- Allergy to Strattera or any of its components
- Narrow angle glaucoma (a condition that causes increased pressure in the eyes and can lead to blindness)
- Treatment with a type of medication called monoamine oxidase inhibitors (MAOIs), such as Nardil® (phenelzine), Parnate® (tranylcypromine), Marplan® (isocarboxazid), or Emsam® (selegeline transdermal system) within 14 days of starting Strattera®
- An adrenal problem called pheochromocytoma or a history of this condition
- Severe heart disease
What are the side effects of Strattera?
The most common side effects in children and adolescents are:
- Upset stomach (e.g., nausea, vomiting)
- Decreased appetite, which may cause weight loss
- Mood swings
- Abdominal pain
The most common side effects in adults are:
- Dry mouth
- Erectile dysfunction
- Urinary tract abnormalities (e.g., trouble passing urine, pain with urination)
- Painful menstruation
- Hot flashes
These side effects can be significant and may require stopping the medication.
However in most cases these side effects are generally not severe. Only a very small percentage of patients needed to stop Strattera due to side effects experienced during clinical trials.
Allergic reactions to Strattera are rare but do occur, usually as swelling or hives. The prescribing doctor or other healthcare professional should be told immediately if anyone taking Strattera develops a skin rash, swelling, hives, or other allergic symptoms.
There have been reports of slightly decreased growth in children and teens. It is recommended that children and adolescents be observed, measured, and weighed periodically while on Strattera.
Strattera should be stopped in patients with signs of jaundice — yellowing of the skin or whites of the eyes. Jaundice is a sign of liver damage. Itching, right upper belly pain, dark urine, and unexplained flu-like symptoms may also be signs of liver injury. If blood tests show evidence of liver damage, the drug should be stopped.
Strattera can increase suicidal thinking in teens who take the drug. Patients should be monitored for suicidal thoughts and actions while taking Strattera®.
Strattera can cause serious heart-related complications (e.g., heart attack, stroke), high blood pressure, and increased heart rate especially in patients with a history of heart and/or vessel disease and/or irregular heart rate. Therefore, patients should be evaluated for heart disease prior to starting Strattera and be monitored for changes in blood pressure and heart rate during therapy.
Strattera should be discontinued if symptoms of psychosis (such as hearing voices, believing things that are not true, being suspicious) or mania occur.
Aggressive or hostile behavior may occur, therefore, monitoring for this type of behavior during Strattera therapy is recommended.
This is not a complete list of all side effects. If you have questions about side effects, please contact your healthcare provider.
Strattera: Tips and precautions
Be sure to tell your doctor:
- If you are nursing, pregnant, or plan to become pregnant
- If you are taking or plan to take any prescription drugs (especially asthma medicines, antidepressants, blood pressure medicines), dietary supplements, herbal medicines, or nonprescription medications (especially cough and cold medicines that contain decongestants)
- If you have any past or present medical problems, including high blood pressure, seizures, heart disease, glaucoma, or liver or kidney disease
- If you have a history of drug or alcohol abuse or dependency or if you have had mental health problems, including depression, manic depression, or psychosis
- If you have had any liver problems or jaundice in the past
- If you become agitated or irritable or if you develop ideas of hurting yourself
Strattera should always be taken exactly as prescribed. It is usually taken once or twice a day and may be taken with or without food. Your physician may adjust the dose until it is right for you or your child. No specific laboratory testing is required while taking Strattera and it may be used for extended, or long-term, treatment as long as there are periodic evaluations with your healthcare provider.
Several types of antidepressant drugs can be used to treat ADHD. Antidepressant therapy for ADHD is sometimes used as the treatment of choice for children or adults who have ADHD and depression.
Antidepressants, however, are generally not as effective as stimulants or Strattera at improving attention span and concentration.
Antidepressants used for treating ADHD include the following:
- Tricyclic antidepressants, such as Pamelor™ (nortriptyline), Tofranil® (imipramine), and Norpramin® (desipramine) have been shown to be helpful in children and adults with ADHD, but they can cause some unpleasant side effects, such as dry mouth, constipation, or urinary problems. They are also relatively inexpensive.
- Wellbutrin® (bupropion), a different type of antidepressant, has been found to be effective in treating ADHD in adults and children. It is generally well-tolerated, but it also has some side effects that may be a problem for some people who have anxiety, headaches, or seizures.
- Effexor® (venlafaxine) and Effexor XR® (venlafaxine extended-release) are newer antidepressants that increase the levels of norepinephrine and serotonin in the brain. The drugs are effective at improving mood and concentration in adults as well as children and teens. They are occasionally used to treat ADHD.
- Monoamine oxidase inhibitors (MAOIs) are a group of antidepressants that can treat ADHD with some benefit, but are rarely used because they have significant and sometimes serious side effects and can dangerously interact with certain foods and other medications. They may be of benefit in situations when other medications have failed. Examples include Nardil® (phenelzine), Parnate® (tranylcypromine), Marplan® (isocarboxazid), or Emsam® (selegeline transdermal system). Monoamine oxidase inhibitors are generally not prescribed for children or teens.
Note: The FDA has determined that antidepressant medications increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, please discuss them with your healthcare provider.
How do antidepressants work?
Since most antidepressants work by increasing the levels of brain messenger chemicals (neurotransmitters), such as norepinephrine, serotonin, and dopamine, it makes sense that they might have effects similar to other ADHD stimulant and nonstimulant treatments that appear to work by similar mechanisms.
Antidepressant treatment can have a small effect on attention span as well as impulse control, hyperactivity, and aggressiveness. Children and adolescents treated with antidepressants are often more willing to take direction and may be less disruptive.
Antidepressants have the advantage of a low potential for abuse, and there is no evidence that they suppress growth or contribute to significant weight loss.
Who should not take antidepressants?
Antidepressants should not be used in the following situations:
- If you have a history or tendency toward manic behavior or manic depression (bipolar disorder).
- Wellbutrin (bupropion) should not be taken if you have any history of seizures or epilepsy.
- Treatment with antidepressants should not be initiated if you have taken a MAO inhibitor antidepressant, such as Nardil, Parnate. Marplan, or Emsam within the last 14 days.
Each type of antidepressant has its own contraindications and usage warnings; you should discuss these with your doctor.
Side effects of antidepressants
The most common side effects experienced with tricyclic antidepressants include:
- Stomach upset
- Dry mouth
- Blurred vision
- Low blood pressure
- Weight gain
- Difficulty urinating
Some tricyclic antidepressants are more likely to cause particular side effects than others.
Tricyclic antidepressants are potentially lethal in the event of an overdose of medication.
Tricyclic antidepressants also have the potential to cause serious heart conduction defects. Periodic electrocardiogram (EKG) monitoring is recommended during tricyclic antidepressant therapy to look for these heart problems.
Wellbutrin sometimes causes stomach upset, anxiety, headaches, and rashes.
Effexor and Effexor XR can cause nausea, anxiety, sleep problems, tremor, dry mouth, and sexual problems in adults.
Monoamine oxidase inhibitors can cause a wide variety of side effects, including dangerously increased blood pressure when combined with certain foods or medications. Prior to starting MAOI therapy, please consult a healthcare professional concerning potential food and drug interactions.
This is not a complete list of all side effects for antidepressants. If you have questions about side effects, please contact your healthcare provider.
Antidepressants therapy: Tips and precautions
When taking antidepressants for ADHD, be sure to tell your healthcare provider:
- If you are nursing, pregnant, or plan to become pregnant.
- If you are taking or plan to take any prescription drugs, dietary supplements, herbal medicines, or nonprescription medications.
- If you have any past or present medical problems, including high blood pressure, seizures, heart disease, and urinary problems.
- If you have a history of drug or alcohol abuse or dependency or if you have had mental health problems, including depression, manic depression, or psychosis.
- If you develop any depressive symptoms or feelings that you might harm yourself.
- If you develop irregular heartbeats (heart palpitations) or fainting spells.
The following are useful guidelines to keep in mind when taking antidepressants or giving them to your child for ADHD:
- Always give the medication exactly as prescribed. If there are any problems or questions, call your doctor.
- Consult your physician prior to discontinuing antidepressant therapy.
- Antidepressants usually take 2-4 weeks before the full effects are apparent. Be patient and don’t give up before giving them a chance to work.
- Your doctor will probably want to start your medication at a low dose and increase gradually until symptoms are controlled.
- It is better not to miss doses of antidepressants. Most are given once or twice a day. If you miss a day or two of Effexor®, it can cause an unpleasant withdrawal syndrome.
- Taking bulk laxatives (fiber) and drinking lots of water is a good idea with tricyclic antidepressants, as they tend to cause constipation and hard stools.
- Tell your doctor if you notice any new or unusual side effects.
Other nonstimulant therapies used to treat ADHD
Two drugs, Kapvay® (extended-release clonidine) and Intuniv® (extended-release guanfacine), have been approved by the Food and Drug Administration for use alone or with stimulant drugs for the treatment of ADHD. These drugs can improve mental functioning as well as behavior in people with ADHD. However, they are usually reserved for those who respond poorly to and cannot tolerate stimulants or Strattera.
Clonidine is also available as a short-acting tablet and as a transdermal patch. Guanfacine is also available as a short-acting tablet. These dosage forms have also been used to treat ADHD, however they are not specifically approved by the FDA for this indication.
How do these drugs treat ADHD?
How these drugs work in treating ADHD is not yet known, but it is clear that they have a calming effect on certain areas of the brain.
Who should not take these drugs?
Kapvay should not be used in patients who are allergic to clonidine (e.g., Catapres®). Intuniv should not be used in patients who are allergic to guanfacine (e.g., Tenex®).
What are the side effects of these drugs?
The most common side effects include:
For Kapvay :
- Upper respiratory infection
- Throat pain
- Change in mood
- Nasal congestion
- Dry mouth
- Ear pain
For Intuniv :
- Stomach pain
These drugs can rarely cause irregular heartbeats. They can lower blood pressure and slow heart rate.
Careful screening for heart rhythm irregularities and regular monitoring of blood pressure and EKGs is recommended.
Both drugs can cause significant drowsiness; use caution when operating dangerous equipment or driving until you know how these drugs affect you.
This is not a complete list of side effects. If you experience a potential side effect while taking these drugs, please consult a healthcare professional.
Other nonstimulant medications: Tips and precautions
When taking one of these drugs for ADHD, be sure to tell your doctor:
- If you are nursing, pregnant, or plan to become pregnant.
- Consult your doctor before discontinuing therapy; Kapvay and Intuniv should not be abruptly discontinued.
- If you are taking or plan to take any prescription drugs, dietary supplements, herbal medicines, or nonprescription medications.
- If you have any past or present medical problems, including low blood pressure, seizures, heart rhythm disturbances, and urinary problems.
- If you develop irregular heartbeats (heart palpitations) or fainting spells.
The following are useful guidelines to keep in mind when taking clonidine or guanfacine or giving them to your child for ADHD:
- Always take or give the medication exactly as prescribed. If there are any problems or questions, call your doctor. It is best not to miss doses as this may cause the blood pressure to rise quickly, which may cause headaches and other symptoms.
- Your health care provider will probably want to start the medication at a low dose and increase gradually until symptoms are controlled.
- For very young children, clonidine short-acting tablets can be formulated into a liquid by a compounding pharmacy to make it easier to give the medication. Short-acting clonidine tablets can be crushed and mixed with food if necessary. However, Kapvay which is a long-acting clonidine tablet should not be chewed, crushed, or broken.
- Intuniv, which is a long-acting guanfacine, should not be chewed, crushed, or broken.
- Do not stop clonidine therapy, including Kapvay, or guanfacine, including Intuniv, suddenly since this can cause a rebound increase in blood pressure. These medications must be tapered.
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Strattera Side Effects
It may take a week or more for this medicine to take effect. This is why it is very important to continue taking the medicine and not miss any doses. If you have been taking this medicine regularly for some time, do not suddenly stop taking it. Ask your doctor or health care professional for advice.
Rarely, this medicine may increase thoughts of suicide or suicide attempts in children and teenagers. Call your child’s health care professional right away if your child or teenager has new or increased thoughts of suicide or has changes in mood or behavior like becoming irritable or anxious. Regularly monitor your child for these behavioral changes.
For males, contact you doctor or health care professional right away if you have an erection that lasts longer than 4 hours or if it becomes painful. This may be a sign of serious problem and must be treated right away to prevent permanent damage.
You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol can make you more drowsy and dizzy. Avoid alcoholic drinks.
Do not treat yourself for coughs, colds or allergies without asking your doctor or health care professional for advice. Some ingredients can increase possible side effects.
Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help.
If you take medication for attention deficit hyperactivity disorder (ADHD), chances are you use a stimulant medication such as Adderall, Ritalin, or Concerta. These types of medication are effective in reducing impulsivity and inattention. However, for many people, they are not an option. Side effects, such as insomnia, loss of appetite, and irritability stop them from using stimulants. Other problems are the increased risk of cardiovascular problems or interference with other medical conditions or medication.
Strattera (atomoxetine) is a non-stimulant medication approved by the FDA to treat ADHD symptoms in children, adolescents, and adults. For some, this medication has proven to be effective. Others find it is not effective at all. Just as with stimulants, Strattera also has side effects that prevent some from taking it. As with all medications, you will need to weigh the pros and cons of the medication and discuss all your treatment options with your doctor.
The Benefits of Strattera
Stimulant medications are Schedule II medications, or controlled substances, meaning that the federal government regulates how the drug is made, prescribed, and dispensed. Your doctor must write a prescription every month and you must present the written prescription to the pharmacy. Your doctor cannot call in the medication, making it inconvenient for many. Since Strattera is not a controlled sbustance, you can receive a prescription for longer than 30 days and your doctor is able to call the pharmacy to fill or refill your prescription, saving you a trip to your doctor’s office each month.
Strattera is not considered to be addictive and does not have “abuse potential.” Because the full effect of Strattera can take up to three to four weeks (which is later listed as a disadvantage) and it does not give a euphoric feeling, it is not used to get high. For adolescents and adults who are prone to substance abuse or addiction, this medication might be a better alternative than stimulant medications.
The medication, when taken as directed, provides 24-hour relief from symptoms of ADHD. That means, as a parent, your child will be able to complete homework in the evening and mornings might not turn into a daily power struggle because the medication is still working.
Strattera appears to have some antidepressant properties and can help those who have symptoms of depression as well as symptoms of ADHD. When taking stimulant medications, those with depressive symptoms may need to add a second medication. With Strattera that may not be needed.
This medication is often a better choice for those with Tourette’s syndrome and ADHD because Strattera does not increase or aggravate tics. It also causes some urinary retention, which in some people may cause a problem but for those children with nocturnal enuresis (bed wetting), Strattera can help. Although you shouldn’t use Strattera specifically for this reason, it may be an added benefit for children struggling with bed wetting.
As with all medications, Strattera does have side effects. Your prescription comes with a warning about a potential for suicide when on this medication. The warning indicates that children and teens may have suicidal thoughts while taking this medication. Other side effects for children and teens include:
- Stomach upset, nausea, vomiting
- Loss of appetite
- Daytime sleepiness
- Mood swings
- Increased heart rate and blood pressure
For adults, the most common side effects are:
- Dry mouth
- Increased menstrual flow and cramps
- Problems urinating or pain when urinating
Another disadvantage is that it takes three to four weeks of sustained used to reach full effectiveness. There may be a number of people that start this medication and give up before waiting a month to decide if it works. Some individuals with ADHD choose to take medication only as needed, when focus and attention are required for a period of time, and to not take it on days when concentration isn’t required. If this is best for you, Strattera isn’t an option. Stimulant medications would be best.
Some men have complained of sexual side effects from Strattera, including a decreased sex drive, impotence, decreased ejaculation amount, or the inability to ejaculate and painful erections.
If you are having any side effects, including sexual side effects, from Strattera, talk with your doctor. Sometimes adjusting the dosage can help alleviate the side effects. In some cases, your doctor might suggest lowering your dosage or trying a different medication.
Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders. Neurology, 2005, A.J. Allen et al, 65(12): 1941-1949
Highlights of Prescribing Insert for Strattera, Revised 2011, Mar, 7, Eli Lilly and Company
What it’s like to live with ADHD so severe it feels like ‘brain fog’
Eliana Courtesy of Eliana Letzter “If you hand me a big text and tell me to read it all, I most likely just flat-out won’t do it,” my sister said.
It’s not that she doesn’t want to. Eliana’s a sharp, hungry learner. But she also has attention-deficit hyperactivity disorder (ADHD), which is sometimes called attention-deficit disorder (ADD) in people like my sister who don’t exhibit many hyperactive symptoms.
Eliana’s is not the sometimes-loses-track-of-her-keys kind of ADD, and not the “oh, isn’t that over-diagnosed?” kind either. My younger sister describes the condition as a “brain fog” that comes and goes over the course of a day.
It’s a disability that’s shaped the course of her life.
ADHD isn’t really one thing — there’s no ADHD spot in the brain, and the disability doesn’t look the same in every person.
Lenard Adler, who directs the Adult ADHD Program at New York University’s Langone Medical Center, describes ADHD as a set of symptoms that tend to travel together. These include struggles with organization, detail-oriented work, and focusing on a task.
ADHD’s hyperactive symptoms make it difficult for some people to stop moving or speaking — as if there were a motor running inside their skulls. People with strong hyperactive symptoms can talk and talk, or jump in when other people are speaking — unaware that they’ve cut someone else off or unable to help themselves. They might fidget, unable to control the urge to move their bodies. Kids with ADHD will often jump from one game to another when playing, unable to focus as long as their friends.
Plenty of people experience distraction and hyperactivity at points in their lives, which is partially why there’s a widespread assumption that the condition has been over-diagnosed. That critique has some merit, but according to the Diagnostic and Statistical Manual of Mental Disorders, a person has to have six attention-deficit symptoms and six hyperactive symptoms for more than six months in order to be diagnosed with ADHD. And those symptoms can’t be traced to another mental illness like depression or schizophrenia.
That means a person with ADHD likely experiences their symptoms as overwhelming and consistent enough to disrupt their lives. Spacing out occasionally doesn’t cut it.
Engaging with the world when you can’t focus
The thing you have to know about Eliana is that she is smart as hell.
Make an argument that she disagrees with and she’ll peel it open, reach inside, and find the flaw at its center. Ask her for an opinion on the rare subject she hasn’t studied, and she’ll come back hours or days later with a fully-formed, deeply-sourced theory of the case.
But her symptoms make it difficult for her to engage with the world in the way people expect.
“People will be talking to me, and I’ll stop hearing what they’re saying,” she said. “And it’s the same sort of thing . I’ll go through the motions, nod my head, mirror their body language and stuff. But the information isn’t coming through.”
Because of this, Eliana can sometimes come off as standoffish.
“Sometimes I’ll take my phone out and read my text messages or something. It’s not because I’m trying to be rude. I’m just not cognizant of what I’m doing.”
Like many kids with ADHD, Eliana spent her school years in a state of almost constant struggle — with homework, with teachers, and with our parents. In elementary school, she’d sit for hours with a book report or set of math problems, straining to focus her attention on the page. When she couldn’t, she would cry, or fight with our parents. After these episodes she would go into her room and stab holes in the wall or beat herself around the head with her hands. Sometimes she hurt herself.
By high school, Eliana had given up on the idea that she’d ever be a good student. She felt dumber than her classmates, she said.
“I could see my classmates finishing the assignments in 10 to 30 minutes,” she said, “But they’d take me hours and hours and hours and sometimes I couldn’t complete them.”
To describe the experience, she said to imagine someone putting a heavy weight in front of you, one you know you can’t pick up. You grab and pull on it anyway, but it won’t budge.
“The processes that needed to go on simultaneously to complete the tasks just wouldn’t line up,” she said.
Variation between cases
ADHD isn’t always this debilitating. Nate Bartlett, a video producer in Chicago (who was, full disclosure, briefly my boss in 2015), says he’s been able to successfully manage his case of ADHD case with coping strategies and medicine.
When his focus slips, he said, he can get stuck in a loop performing some other, meaningless task — losing time and energy he hoped to devote to work. Nate was diagnosed in early high school, so he was allowed extra time on tests and the SATs — enough to account for the time he lost to his wandering mind.
“I remember thinking , ‘Oh, I wish I’d done this a few years ago,'” he said.
Nate managed his symptoms without medication until college, where he struggled to find places in which he could focus on his studies. Even the library was too distracting, he said — he’d find himself scanning book titles rather than preparing for a test. So, for the first time, he got a prescription for Adderall, an amphetamine and stimulant that can help people with ADHD regulate their attention.
Adderall stimulates cells in the brain to produce more chemicals called neurotransmitters — chemical messengers that help nerves pass information around in the brain. Psychiatrists think those extra neurotransmitters can help people with ADHD focus, though the exact mechanisms aren’t entirely understood.
There are also several classes of non-stimulant medications for ADHD, the most common of which is known by its brand name Strattera. Rather than stimulate more neurotransmitter production, Strattera prevents a patient’s brain from clearing out neurotransmitters it has already produced. Clonidine is also a fairly common non-stimulant treatment that has been found to help patients.
According to Adler, doctors don’t prescribe Adderall and other stimulants lightly, since they can have harmful side effects and come with the risk of patients abusing them as recreational drugs.
Nate said that aside from a somewhat unpleasant rapid heartbeat (a common side-effect), Adderall was a positive force in his life. He learned to use it as a tool to get through his work, rather than as a crutch. Now that he’s working full time, he doesn’t take the drug anymore — instead, he relies on coping mechanisms like playing loud music in his headphones while he works and isolating himself in a private office.
Eliana’s experience with medication wasn’t as smooth. Throughout middle school, doctors prescribed her a range of pills — Strattera, Adderal, and others — with limited success.
“I’d given up.” she said. “Just the idea of being competent in school was, like, so far-fetched.”
When treatments don’t work
Eliana stopped taking medication by the time she got to high school, and sought out other ways to cope.
“I turned to marijuana, really heavy marijuana use. Obviously it doesn’t treat the symptoms but it sort of mutes them and dampens them,” she said.
After high school, she went on a gap year program where a few other people also had ADHD. She began getting a prescribed medication, Vyvanse (another amphetamine), from a roommate in exchange for doing his homework.
“He would give me a Vyvanse, and I would write his essay for him,” she said.
It was enough to suck her in — uncontrolled by a doctor or limited by a prescription, Eliana started to overuse the drug.
Alex Dodd/flickr “I would spend the entirety of the ‘high’ writing the essay, but I still sought it out,” she said. “Really all I was doing was writing his essay for him with the medication he was supposed to take to write his essays, but it was so satisfying and gratifying that I did it.”
She became addicted. Although we spoke all the time back then, I didn’t notice anything wrong. She sounded better, happier, and more sure of herself than she had in high school.
“To a large extent what I became addicted to was the ability to write, she said. “I would take in order to be able to write for extended periods, or read things. But because I wasn’t in a healthy environment and I wasn’t in a healthy mental state, it got real bad.”
Eventually, she got her own amphetamine prescription, but continued abusing the pills. Eliana experienced multiple bouts of stimulant psychosis — a condition marked by disordered thoughts and delusions. The same medicines that cleared her brain fog could act as poisons, mixing her head up in a different way.
Eliana has since kicked the pill habit and made a few stabs at community college, but none of them have stuck. Her disability and lack of college degree make it hard for her to get regular work. Instead, she devotes a lot of time to volunteering, organizing, and protesting with activist groups. Not being able to read still frustrates her constantly.
“I’ll find myself reading something, then not knowing what I read. My eyes will scan the words, and some part of my brain is playing them in my head, but the information isn’t actually penetrating,” she said.
Her current doctor won’t prescribe her stimulants, fearing her history of addiction. According to Adler, that’s one of the biggest concerns for doctors treating ADHD. Nonetheless, Eliana wishes there were a doctor willing to work with her to find a safe medication regimen.
Right now, her doctor is pushing her toward a common treatment for severe ADHD that doesn’t involve medication: cognitive behavioral therapy, or CBT. The goal is to get patients to confront situations that trigger their symptoms, and slowly retrain their brains to respond more productively. Psychiatrists also use CBT to manage other mental illnesses, including depression and obsessive compulsive disorder.
But Eliana doesn’t want to try it. To her, CBT feels more like an effort to make her into a productive member of the workforce than to alleviate the symptoms she finds most painful.
For now, she’s given up on treatment.
Approximately 10 million adults have attention-deficit/hyperactivity disorder (ADHD). Although there is a significant amount of research on medication treatment for children with ADHD, much less controlled research data has been conducted on medication therapy in adults. As a treatment of ADHD, it has been said that “pills do not substitute for skills.” This means that medication alone is not sufficient to help a person improve his or her problems in areas such as organization, time management, prioritizing and using cognitive aids. However, medication improves attention and reduces impulsivity in adults who have been correctly diagnosed with ADHD. Adults with ADHD may also frequently have other conditions such as depression or anxiety that may require additional treatment.
How medication works
Medication does not cure ADHD; when effective, it eases ADHD symptoms during the time it is active.Thus, it is not like an antibiotic that may cure a bacterial infection, but more like eyeglasses that help to improve vision only during the time the eyeglasses are actually worn.
Medications that most effectively improve the core symptoms of ADHD seem primarily and directly to affect certain neurotransmitters (brain molecules that facilitate the transmission of messages from one neuron to another). The neurotransmitters involved are dopamine and norepinephrine. Both neurotransmitters appear to play a role in the attentional and behavioral symptoms of ADHD. Practitioners cannot know in advance what drug will work best for a particular patient without trying them. Doctors will use a medication trial to figure out which medicine works best for each individual and at what dosage. The trial usually begins with a low dose that is gradually increased at 3–7 day intervals until clinical benefits are achieved.
Psychostimulant compounds are the most widely used medications for the management of ADHD symptoms in adults as well as children and adolescents. Several long-acting psychostimulants are approved by the Food and Drug Administration (FDA) for the treatment of ADHD in adults and are routinely prescribed. The two stimulants most commonly used, methylphenidate (MPH) and amphetamines (AMP), are regulated as Schedule II drugs by the Drug Enforcement Administration (DEA) because they have a potential for abuse when not used as prescribed by a medical professional. ADHD medications approved for adults include methylphenidate; Focalin, Focalin XR; Concerta; Daytrana; Metadate CD; and the amphetamines, Adderall XR and Vyvanse.
Short-acting preparations generally last approximately 4 hours; long-acting preparations are more variable in duration—with some preparations lasting 6–8 hours and newer preparations lasting 10–12 hours. Of course, there can be wide individual variation that cannot be predicted and will only become evident once the medication is tried.
Since effective longer-acting formulations of stimulants became available, many children, adolescents and adults have found these preferable. Longer-acting medications may cause fewer “ups and downs” over the day and may eliminate the need for taking additional doses at school or during work. Although there is little research on utilizing short-acting and long-acting medications together, many individuals, especially teenagers and adults, find that they may need to supplement a longer-acting medication taken in the morning with a shorter-acting dose taken in the mid to late afternoon. The “booster” dose may provide better coverage for doing homework or other late afternoon or evening activities and may also reduce problems of “rebound” when the earlier dose wears off.
Hundreds of controlled studies involving more than 6,000 children, adolescents and adults have been conducted to determine the effects of psychostimulant medications—far more research evidence than is available for virtually any other medication. There are no studies on the use of psychostimulant medications for more than a few years, but many individuals have been taking these medications for many years without adverse effects. Longer term controlled studies cannot be done because withholding treatment over many years from some patients suffering significant impairments, which is required in a controlled study, would be unethical.
Frequently asked questions about psychostimulants
Q. When an adult has been diagnosed with ADHD and decides to seek medical treatment, should the person try MPH or AMP first?
A. There is no scientific basis for choosing one type of stimulant over the other for a given individual who has not yet tried either. Because MPH and AMP affect dopamine and norepinephrine somewhat differently, they also affect people differently.
Both MPH and AMP block the reuptake of dopamine and norepinephrine and increase their levels in the synapse (space where the brain cells connect). AMP also increases the levels of dopamine and norepinephrine in the synapse through another mechanism in the pre-synaptic (pre-connection) brain cell.
If one family of stimulants does not improve ADHD symptoms, the practitioner can try a different type. Because MPH and AMP have different mechanisms of action, combining MPH and AMP may be useful in a person who does not respond to either type alone.
Q. Are adults who take psychostimulant medications more likely to have substance abuse problems?
A. No. Generally, the stimulants are well tolerated in therapeutic doses without any abuse. There is no evidence to substantiate the fear that stimulant use leads to substance abuse or dependence. On the contrary, studies indicate that successful treatment of ADHD with stimulants lowers the chances of substance use disorders, compared to adults with untreated ADHD.
Adults with ADHD who have a co-existing substance use disorder and are actively using sometimes abuse psychostimulants. Generally, the active substance use disorder needs to be treated before the co-existing ADHD can be treated. In this case, it may be advisable not to use a psychostimulant for the treatment of ADHD. For people with a recent history of substance use but no current use, deciding to use stimulant medication needs to be dealt with on a case-by-case basis. Certain extended release preparations, such as Concerta (an extended release form of MPH with an delivery system that cannot be crushed and used other than as prescribed orally), are less likely to be abused.
Q. What are the possible side effects of stimulant use in adults with ADHD?
A. Side effects of stimulant use in adults are generally not severe. For MPH, one controlled study showed side effects such as insomnia, headaches, anxiety, loss of appetite, weight loss (but less weight loss than is seen in children) and some cardiovascular effects. The cardiovascular effects in those with normal blood pressure include increases in blood pressure (systolic and diastolic increases of about 4 mm Hg) and increases in heart rate (less than 10 beats per minute). A few long-term large-scale controlled studies of cardiovascular effects have been published. These studies found that stimulant use was not associated with increased risk of heart attacks, cardiac death or stroke. In addition, a study of adults with well-controlled hypertension showed that ADHD could be safely and effectively managed with mixed amphetamine salts. Regular monitoring of blood pressure is generally recommended in adults with or without ADHD.
Other stimulant treatment considerations
Matching the characteristics of the various extended release stimulants with the needs of the adult requires both knowledge of these medications as well as an understanding of the specific needs of the adult with ADHD and how these needs change over time. It is often useful for the prescribing professional and adult to chart the adult’s needs and individual response to the medication. Adjustments may require changing the amount and/or timing of the dosing, changing the extended release stimulant to one with different characteristics, or adding an immediate release preparation at the beginning, middle or end of the extended release preparation’s action. For example, if an adult has a business meeting later in the day or after dinner, he or she could take the extended release medication later than usual or add an immediate release dose or two late in the day.
With the exception of atomoxetine (Strattera), which will be discussed below, non-stimulant medications have generally been considered second-line medications. They have been used in people who have an incomplete response or no response to stimulants, cannot tolerate stimulants or have certain co-existing psychiatric conditions.
Atomoxetine (Strattera) is approved by the FDA for the treatment of ADHD in children, adolescents and adults. It is a potent selective norepinephrine reuptake inhibitor. It is the first nonstimulant medication to be approved by the FDA for the treatment of ADHD and the first medication of any kind specifically approved for the treatment of ADHD in adults. It lacks the abuse potential of stimulants, and since it is not a controlled Schedule II drug, atomoxetine can be prescribed by telephone and with refills.
While the effects of stimulants are almost immediate, atomoxetine takes longer to produce a response. In controlled studies of adults, atomoxetine was associated with cardiovascular side effects including increased heart rate of five beats per minute and an increase in blood pressure of 3 mm Hg for systolic and 1 mm Hg for diastolic blood pressure. No controlled studies comparing the cardiovascular effects of atomoxetine and of stimulants have yet been published. Other side effects can include dry mouth, insomnia, nausea, constipation, decreased appetite, dizziness, decreased libido, erectile disturbance, and urinary retention, hesitation or difficulty. Atomoxetine may lead, in rare cases, to severe liver injury resulting in liver failure if not stopped immediately on finding any liver effects (itching, dark urine, right upper quadrant tenderness or unexplained “flu-like” symptoms).
In a long-term, open label study of atomoxetine, two-thirds of adults with ADHD continued to have a positive therapeutic response through an average of 34 weeks.
Atomoxetine is metabolized (broken down) in the liver by the CYP2D6 enzyme. Drugs that inhibit this enzyme, such as fluoxetine, paroxetine and quinidine, can inhibit this enzyme and slow the metabolism of atomoxetine. Decreasing the dosage of atomoxetine may be necessary when the person is taking these medications. Atomoxetine (as with the stimulants and TCAs) should not be taken with a mono-amine oxidase inhibitor (MAOI) or within two weeks of discontinuing a MAOI. Likewise, treatment with a MAOI should not be initiated within two weeks of discontinuing atomoxetine.
Antidepressants that have a direct effect of increasing the neurotransmitter norepinephrine (but not serotonin as in the selective serotonin reuptake inhibitors like fluoxetine) appear to have a positive effect on the core symptoms of ADHD. None of the antidepressants has been approved by the FDA for the treatment of ADHD in children, adolescents or adults; such treatment is considered off-label.
Clonidine (Catapres; Kapvay) and guanfacine (Tenex; Intuniv) are alpha-2 and alpha-2a noradrenergic agents, respectively, that may indirectly affect dopamine by first affecting norepinephrine. Although they have been used to help children who have ADHD with hyperactive and aggressive symptoms, their use in adults has been generally minimal. A few small controlled studies have shown some efficacy of guanfacine in adults with ADHD. However, sedation and blood pressure lowering effects as well as potential hypertensive rebound are issues of concern. Long-acting preparations of clonidine Kapvay and guanfacine have been approved for ADHD in children and may also be helpful in adults.
Modafinil (Provigil) is approved by the FDA for the treatment of narcolepsy. Its main effect appears to be indirect activation of the frontal cortex rather than direct involvement in central dopamine and norepinephrine pathways. In a two-week, controlled study of modafinil, 48% of adults with ADHD responded favorably to the medication. Longer, controlled studies in adults are clearly needed. At this time, modafinil’s utility may be limited to adults with ADHD who do not respond to first line medications. A variation of modafinil, armodafanil (Nuvigil) has become available in the United States; its effects on ADHD in adults have not yet been studied.
Choosing a medication
It is crucial for individuals to work with their health care professional to match their needs with the characteristics of the ADHD medication. The process of choosing a medication should involve recognizing the negative side effects of a medication so that the risks and benefits can be adequately weighed in the decision. It is often useful to construct a daily timeline of the needs (both attentional and behavioral) of the adult.
For example, an adult who has severe ADHD symptoms that threaten his/her job may also have difficulty controlling his/her hypertension. In this case, choosing a treatment for ADHD that has a significant effect during the most crucial hours of the work day but does not destabilize the tentatively controlled hypertension will require knowledge of the medications’ actions over time as well as their cardiovascular side effects.
Monitoring the effects of medication
Monitoring the effectiveness of medication over time is important and may require substantial effort. However, fine tuning of the timing and dosing of the medication can often improve the time-related clinical response. Sometimes the prescribing professional alone may fulfill these functions; sometimes an experienced therapist who is familiar with the adult can provide additional input to help maximize the effectiveness of the medicine. Clinical adjustment may include adding other medications or adding or changing the psychosocial interventions, such as behavioral, cognitive or supportive psychotherapy, coaching, and tutoring.
Improving functioning and quality of life
While improvement of the core symptoms of ADHD is important and crucial, it is often not the only goal of treatment. Rather, improved functioning in the real world (being self-sufficient, having a better quality of life and being able to cope with the demands of daily life) may be the most important outcome for an adult with ADHD. Controlled medication studies in adults with ADHD have begun to track and measure these functional improvements including psychosocial and quality of life functioning. Future controlled, long-term medication studies in adults with ADHD are needed to accurately measure the effect of medication on functioning in the workplace, college and interpersonal relationships.
Medication therapy in adults with ADHD and co-existing psychiatric disorders
Approximately two-thirds to three-quarters of adults with ADHD will have at least one other psychiatric disorder during their lifetime. These other disorders include antisocial personality disorder, anxiety disorders, depressive disorders, bipolar disorder, and substance use disorders (SUD). After diagnoses have been made, the clinician and adult should decide which diagnoses need to be treated and in what order.
There is no controlled research on medication therapy in adults with ADHD and co-existing conditions. The treatment decisions of the medical professional and the individual will be guided by their previous therapeutic and clinical experience, extrapolations from others’ clinical experiences, and a rational, empirical approach to the individual’s clinical response.
Significant co-existing conditions are usually treated first, before ADHD, especially if they cause more significant clinical and functional impairment and disturbance. This is particularly true with substance use disorders, severe depression and bipolar disorder, psychoses, and homicidal or suicidal ideation. It is important to consider how the ADHD may be affected by medication for a co-existing disorder—both positive and negative, both helpful and harmful. For example, treating depression with bupropion may also help ADHD. On the other hand, some medications for major depression and bipolar disorder may actually worsen ADHD symptoms. The SSRIs (selective serotonin reuptake inhibitors), which by themselves do not effectively treat ADHD symptoms directly, appear to be successful in the treatment of individuals who have co-existing depression and who are taking stimulants at the same time for ADHD.
It is also important to note that medications for ADHD may affect co-existing disorders. For example, psychostimulants may worsen an untreated anxiety or bipolar disorder. The risk of stimulant abuse is also greater in adults with substance use disorder and are actively using. However, as previously mentioned, successful treatment of ADHD tends to decrease the chances of a person with ADHD eventually developing an SUD.
Some nonstimulant treatments of ADHD may simultaneously and adequately treat the co-existing disorder along with the ADHD. For example, an antidepressant (TCA, bupropion, venlafaxine) may effectively treat co-existing depression and ADHD, and similarly, a TCA or venlafaxine may successfully treat co-existing anxiety and ADHD.
Discuss the specifics of any medication with your physician or medical professional. New medications for the treatment of ADHD continue to be formulated and researched every day. Similarly, researchers continue to explore the use and effectiveness in the treatment of ADHD of medications that were used previously to treat other conditions.
What is Strattera?
Strattera (atomoxetine) is designed to treat Attention Deficit Hyperactivity Disorder in children and adults.
How does Strattera work?
Strattera is a medication known as a norepinephrine reuptake inhibitor (NRI) that has been approved for the treatment of ADHD in children and adults. It works by affecting chemicals in the brain and nervous system that influence hyperactivity and impulse control.
When did the U.S. Food and Drug Administration (FDA) approve Strattera?
Strattera was the first non-stimulant approved to treat ADHD in children and adolescents in the United States, approved by the FDA for adults in 2006 and for children 6 and over in 2008.
Is there a generic version of Strattera available?
There is currently no generic version for Strattera. The earliest one could possibly become available would be when the patent for the drug expires in 2017.
Are there any major differences between Strattera and other ADHD medications?
Many drugs used to treat ADHD, such as Ritalin and Adderall, are stimulants. These medications can be habit-forming and are classified as controlled substances. Strattera, however, is not a controlled substance and is not habit-forming. This means you do not have to taper off the use of Strattera if you decide to stop taking the medication. However, the tradeoff is that it may take a month or two for the medication to reach its full efficacy.
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Can children take Strattera?
Children over the age of 6 may be prescribed Strattera for ADHD. They should take the medication in the exact amount prescribed by their doctor. It’s also important to tell your child’s doctor about other medication complications, past substance use history, and any history of suicidal thoughts.
Are there potential interaction issues for people taking Strattera and any other drugs?
Do not take Strattera if you, or your child, have taken an MAO inhibitor in the past two weeks, as a dangerous interaction effect could occur. There are also many drugs which are known to interact with Strattera in major, moderate, or mild ways, so let your doctor know what other medications you are taking before you begin Strattera therapy.
Are there any other medical conditions that would make someone ineligible for Strattera therapy?
You should not take Strattera if you are allergic to anything in the medication. Also if you have glaucoma or have had a rare tumor called pheochromocytoma, you should not take Ritalin. Also talk to your doctor if you have had heart problems, high or low blood pressure, liver problems, or a history of mental illness such as depression or bipolar disorder. Also, if you or your child has a history of suicidal thoughts or action, talk to your doctor about the risks.
What is the typical dose that would be prescribed to someone taking Strattera?
Dosage for children varies depending on the age and weight of a child. According to drugs.com, the maximum recommended total daily dose for children and adolescents over 70kg and adults is 100 mg. Strattera can be taken with or without food.
How long does it usually take for Strattera to work?
Some people report small changes in hyperactivity and impulse control within two weeks, but it may take 4 to 8 weeks for the drug to achieve maximum effectiveness.
What do I do if I miss a dose?
If you miss a dose, you can take the medication as soon as you remember that day. Never, however, double your dose the next day if you miss a day.
What are the most common side effects of Strattera?
Common side effects of Strattera among children and adolescents include:
- nausea or vomiting
- decreased appetite
- mood swings.
Common side effects of Strattera among adults include:
- dry mouth
- problems urinating
- decreased appetite
- sexual side effects.
Major side effects should be reported to your doctor immediately, and can include liver injury, heart-related problems, and stroke. You can also report them to the FDA at 1-800-FDA-1088 or online.
Are there any psychiatric side effects that come from taking Strattera?
Strattera has been shown to increase suicidal thoughts and actions among some children and teens. In one clinical study, 4 out of 1,000 patients reported having suicidal thoughts, with no suicides occurring. Talk to your doctor if your child or teen has a history of suicidal thoughts or actions before they begin Strattera therapy.
Is it safe for a woman who is pregnant, trying to become pregnant, or nursing to take Strattera?
There are no controlled studies on human pregnancy and Strattera, and the drug is only recommended during pregnancy when the benefits outweigh the risks. The drug may be transferred via breast milk in small amounts, although there have been no current human studies. Therefore, talk to your doctor if you are pregnant, planning to become pregnant, or are nursing before you take Strattera.
Can symptoms occur if Strattera is discontinued?
There is no current evidence of withdrawal symptoms when Strattera use is discontinued.
If taken in overdose, is Strattera toxic?
An overdose of Strattera could be fatal, so seek immediately help or call the Poison Help Line at 1-800-222-1222 if you overdose. Overdose symptoms can include sleepiness, behavior changes, nausea and vomiting, blurred vision, rapid heartbeat, hallucinations, seizures, pupil enlargement, and increased heart rate.
Is Strattera habit-forming?
Unlike some other ADHD medications, Strattera is not habit-forming and not prone to abuse.
How much does Strattera cost?
Thirty 40 mg capsules of Strattera cost approximately $420. It’s possible the drug may become cheaper in the future once a generic version is available.
Are there any disadvantages to taking Strattera?
Some studies have found that Strattera does not perform as well as stimulants in treating ADHD. Another disadvantage is that it can take a month or two for the drug to reach its full efficacy. The drug may also cause suicidal thoughts in children or adolescents, so it’s important to monitor children carefully when they are taking the medication.
DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.
Last Updated: Nov 12, 2019
Medically reviewed by ADDitude’s ADHD Medical Review Panel
What is Strattera?
Strattera (Generic Name: atomoxetine hydrochloride) is an alternative to the stimulant ADHD medications most commonly used to treat symptoms of attention deficit hyperactivity disorder (ADHD or ADD) 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). Stimulant ADHD medications are often the first-recommended treatment, but Strattera is a good alternative for people who cannot tolerate, or don’t experience the desired effects of, stimulant medication.
The American Academy of Pediatrics recommends ADHD treatment with behavioral therapy before medication for children under the age of 6. For children ages 6 to 11, the AAP says “The primary care clinician should prescribe US Food and Drug Administration–approved medications for ADHD and/or evidence-based parent- and/or teacher-administered behavior therapy as a treatment for ADHD, preferably both.” Likewise, the National Institute of Mental Health finds the most successful treatment plans use a combination of ADHD medication, such as Adderall XR, and behavioral therapy.
Before starting or refilling a Strattera prescription, read the medication guide included with your pills, as it may be updated with new information.
This guide should not replace a conversation with your doctor, who has a holistic view of your or your child’s medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.
What is the Typical Dosage for Strattera?
As with all medications, follow your Strattera prescription instructions exactly. Strattera is taken orally, with or without food, once or twice daily. 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.
Capsules are available in 10mg, 18mg, 25mg, 40mg, 80mg, and 100mg dosages. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day.
The optimal dosage varies patient by patient. Your doctor may adjust your daily dosage after 3 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. The maximum recommended dosage is 100mg/day.
During treatment, your doctor may periodically ask you to stop taking your Strattera so that he or she can monitor ADHD symptoms; 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 Associated with Strattera?
The most common side effects of Strattera are as follows:
Children and adolescents (ages 6 – 17): upset stomach, decreased appetite, nausea, and vomiting.
Adults: constipation, dry mouth, nausea, decreased appetite, dizziness, sexual side effects, and problems passing urine.
Other serious side effects include the following: severe allergic reaction, slowed growth in children, priapism, and 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.
Taking Strattera may impair your or your teenager’s ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor. Most people taking this medication do not experience any of these side effects.
Disclose to your physician all mental health issues including any family history of suicide, bipolar illness, or depression. The FDA recommends evaluating patients for bipolar disorder 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. 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.
Discuss any existing liver problems with your doctor. Strattera can cause severe liver injury for some patients. 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.
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.
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.
Other Precautions and Interactions Associated with Strattera
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.
You should not take Strattera if you have:
- taken, or plan to take an antidepressant monoamine oxidase inhibitor or MAOI within 14 days
- narrow-angle glaucoma
- an allergy to any ingredients
- 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.
The effects of Strattera on children under 6 and on the elderly have not been studied.
Before taking Strattera, discuss all other active prescription medications with your doctor. Strattera can have a dangerous interaction with antidepressants including MAOIs, asthma medicines, blood pressure medicines, and cold or allergy medicines that contain decongestants.
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:
A Parent’s Guide to Psychiatric Medications for Children with ADHD
How Does ADHD Medication Work? Your First Questions Answered.