Strattera: Non-Stimulant ADHD Treatment for Sustained Focus
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Synonyms | |||
Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor (SNRI) approved for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children, adolescents, and adults. As the first non-stimulant medication specifically developed for ADHD management, it offers a distinct pharmacological profile, providing continuous symptom control without the potential for abuse or dependence associated with stimulant therapies. Its mechanism focuses on enhancing norepinephrine transmission in the prefrontal cortex, a key region for attention and executive function. This product card provides comprehensive, evidence-based information for healthcare professionals and informed patients considering this treatment option.
Features
- Active ingredient: Atomoxetine hydrochloride
- Available in capsule formulations: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg
- FDA-approved for ADHD in patients aged 6 years and older
- Non-controlled substance (no abuse potential)
- Once- or twice-daily dosing regimens
- Onset of therapeutic effect typically within 2–4 weeks
Benefits
- Provides 24-hour symptom control with steady-state plasma concentrations
- Eliminates concerns regarding diversion, misuse, or dependency
- Suitable for patients with comorbid anxiety or substance use disorders
- Does not require drug holidays or frequent dose adjustments
- May improve emotional regulation and reduce rejection sensitive dysphoria (RSD) in some individuals
- Compatible with a range of concomitant medications where stimulants may be contraindicated
Common use
Strattera is indicated for the management of ADHD symptoms, including inattention, hyperactivity, and impulsivity, in pediatric and adult populations. It is often selected for patients who have not responded adequately to or cannot tolerate stimulant medications. It is also considered a first-line option for individuals with a history of substance misuse, anxiety disorders, tic disorders, or cardiovascular concerns that may preclude stimulant use. Clinical studies support its efficacy in improving academic, occupational, and social functioning.
Dosage and direction
Dosing is weight-based for patients under 70 kg: initiate at approximately 0.5 mg/kg/day, increase after a minimum of 3 days to a target daily dose of 1.2 mg/kg, administered either once daily or divided into two doses (morning and late afternoon/early evening). For patients over 70 kg, initiate at 40 mg daily, increase after a minimum of 3 days to a target dose of 80 mg/day. Maximum recommended daily dose is 100 mg. Capsules should be swallowed whole and may be taken with or without food. Avoid opening or chewing capsules.
Precautions
Monitor for the emergence of agitation, irritability, suicidal thinking, or unusual changes in behavior, particularly during initial months of therapy or after dose changes. Hepatic function should be assessed at baseline and periodically thereafter; dose reduction is recommended in patients with moderate to severe hepatic impairment. Use caution in patients with hypertension, tachycardia, or cardiovascular disease. May cause orthostatic hypotension and syncope, especially during initial dose titration. Not recommended in patients with narrow-angle glaucoma.
Contraindications
Hypersensitivity to atomoxetine or any component of the formulation. Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy due to risk of serotonin syndrome. Severe cardiovascular disorders that could be exacerbated by increases in blood pressure or heart rate. Pheochromocytoma or history of pheochromocytoma.
Possible side effect
Common adverse reactions (≥5% and twice the rate of placebo) include: nausea, vomiting, fatigue, decreased appetite, abdominal pain, somnolence, and dizziness. Less frequently, patients may experience dry mouth, constipation, dyspepsia, mood swings, insomnia, and increased sweating. Pediatric patients may exhibit weight loss and slight reductions in growth rate during extended therapy. Rare but serious effects include severe liver injury, angioedema, urticaria, priapism, and cardiovascular events.
Drug interaction
Strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine) may increase atomoxetine exposure—dose adjustment is necessary. Avoid concomitant use with medications that increase norepinephrine (e.g., MAOIs, pressor agents). May enhance effects of albuterol and other beta-agonists on cardiovascular system. Use cautiously with other drugs affecting serotonin (e.g., SSRIs, SNRIs, triptans) due to potential serotonin syndrome risk.
Missed dose
If a dose is missed, it should be taken as soon as possible on the same day. However, if it is near the time of the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration.
Overdose
Symptoms may include somnolence, agitation, hyperactivity, abnormal behavior, gastrointestinal symptoms, tachycardia, hypertension, and mydriasis. There is no specific antidote; provide supportive care and monitor cardiac and vital signs. Gastric lavage and administration of activated charcoal may be considered if presented early. Hemodialysis is not likely to be effective.
Storage
Store at room temperature (20–25°C/68–77°F); excursions permitted between 15–30°C (59–86°F). Keep in original container, tightly closed, and protect from light and moisture. Keep out of reach of children and pets.
Disclaimer
This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or altering any medication regimen. Individual response to therapy may vary based on health status, comorbidities, and genetic factors.
Reviews
Clinical trials and post-marketing studies consistently demonstrate Strattera’s efficacy in reducing core ADHD symptoms across age groups. Many patients and clinicians report appreciable improvements in attention span, task completion, and organizational skills without the “rebound” effects sometimes seen with stimulants. Criticisms often relate to its slower onset of action and gastrointestinal side effects during initiation. Overall, it remains a valuable option within the ADHD treatment arsenal, particularly for those requiring a non-stimulant approach.