Strattera (Atomoxetine)

Overview

Strattera, the brand name for atomoxetine, is a selective norepinephrine reuptake inhibitor (SNRI) medication primarily used to treat attention deficit hyperactivity disorder (ADHD) in children, adolescents, and adults.¹² Unlike stimulant medications, it is a non-stimulant option that helps increase attention span, reduce impulsivity, and decrease hyperactivity as part of a comprehensive treatment program that may include counseling or therapy.¹⁴ Originally developed in the 1990s, it was approved by the FDA in 2002 for ADHD treatment after demonstrating efficacy in clinical trials, with its patent expiring in 2017 allowing generic versions.² Atomoxetine is not approved for children under 6 years old and is taken orally in capsule form.¹⁸ It works by selectively inhibiting the reuptake of norepinephrine, a neurotransmitter involved in attention and arousal, without significantly affecting dopamine in a manner similar to stimulants.⁴

Forms and Variations

Strattera is available exclusively as oral capsules containing atomoxetine hydrochloride, with strengths ranging from 10 mg to 100 mg to accommodate different dosing needs.¹⁴ Capsules must be swallowed whole and should not be crushed, chewed, or opened due to the risk of altered release and increased side effects.⁶ Generic atomoxetine capsules are widely available following patent expiration, offering the same active ingredient at potentially lower costs.² There are no liquid, chewable, or extended-release variations beyond the standard capsule form.⁹ The choice of strength is determined by a healthcare provider based on body weight, age, and response, starting low and titrating upward for safety.¹ Capsules come in various colors for easy identification of dosages.

Dosage and Administration

Dosage for Strattera is individualized, typically starting at 0.5 mg/kg/day for children and adolescents (or 40 mg/day for adults), increasing after at least 3 days to a target of 1.2 mg/kg/day or 80 mg/day, with a maximum of 1.4 mg/kg/day or 100 mg/day.¹ It is usually taken once daily in the morning or divided into two doses (morning and late afternoon/early evening) to minimize insomnia.¹⁵ Strattera can be taken with or without food, but consistency aids adherence; if a dose is missed, take it as soon as remembered unless near the next dose—do not double up.¹⁶ Full effects may take 4-8 weeks, so regular monitoring by a doctor is essential, including checks for growth in children and blood pressure in all users.⁶ Always follow a healthcare provider"s instructions precisely.

Scientific Research and Mechanism of Action

Atomoxetine selectively inhibits the norepinephrine transporter (NET), increasing norepinephrine and dopamine levels particularly in the prefrontal cortex, which enhances executive function, attention, and impulse control without the abuse potential of stimulants.²⁸ Key clinical trials supporting FDA approval in 2002 showed significant symptom reduction in ADHD across age groups, with efficacy comparable to methylphenidate in some studies but with a slower onset.²⁶ Research indicates benefits for both inattentive and hyperactive-impulsive subtypes, and it may be used adjunctively with stimulants.² Ongoing studies explore its role in cognitive disengagement syndrome (CDS), though evidence is preliminary.² Long-term data support sustained efficacy with monitoring for growth and cardiovascular effects; however, it carries a black box warning for suicidality risk in youth.³ Current research emphasizes its utility in patients intolerant to stimulants or with comorbid anxiety.⁸

Benefits and Potential Uses

Strattera effectively improves ADHD core symptoms: inattention, hyperactivity, and impulsivity, enhancing focus, academic/work performance, and social functioning in children (over 6), teens, and adults.¹³⁴ Proven benefits include reduced restlessness, better concentration, and decreased distractibility as part of multimodal therapy.⁷ It is particularly valuable for non-responders to stimulants, those with tics, anxiety, or substance use history due to low abuse potential.⁶⁸ Potential uses extend to cognitive enhancement in CDS and adjunct therapy, though not FDA-approved for these.² Studies show sustained symptom control over months to years with proper dosing, and it may support emotional regulation.⁶ Unlike stimulants, it provides 24-hour coverage without peaks/troughs.⁹

Side Effects and Risks

Common side effects include dry mouth, nausea, decreased appetite, dizziness, fatigue, constipation, insomnia, and urinary problems; in adults, sexual side effects and menstrual cramps may occur.¹³⁵ Serious risks encompass liver injury (symptoms: jaundice, dark urine, abdominal pain), priapism (prolonged erection), severe allergic reactions, and increased heart rate/blood pressure.¹³ It carries a black box warning for suicidal thoughts/behaviors in children/teens, especially early in treatment.³⁶ Children may experience growth suppression, requiring monitoring.⁵ Use caution in those with heart defects, bipolar disorder, or psychosis history.¹

Interactions and Precautions

Strattera must not be taken with monoamine oxidase inhibitors (MAOIs) within 2 weeks due to risk of hypertensive crisis or serotonin syndrome.¹³⁵ It interacts with blood pressure medications, beta-2 agonists (e.g., albuterol), decongestants (e.g., pseudoephedrine), and CYP2D6 inhibitors (e.g., fluoxetine), potentially altering levels or effects.³⁶ Precautions apply to pregnant/breastfeeding individuals (limited data), those with glaucoma, liver/heart issues, or bipolar disorder.¹ Monitor blood pressure and heart rate regularly; avoid abrupt discontinuation.⁷ Inform surgeons before procedures due to blood pressure effects.³

Impact on Biomarkers

Strattera can elevate heart rate and blood pressure, necessitating regular monitoring via vital signs checks.¹⁶ Liver function tests (e.g., ALT, AST) should be assessed if symptoms arise, as it rarely causes hepatotoxicity.¹³ In children, track height and weight percentiles for growth impacts.⁵ It may influence mood-related biomarkers indirectly through psychiatric monitoring.

Overdose and Toxicity

Overdose risks include seizures, cardiac arrest, psychosis, and agitation; symptoms mimic serotonin syndrome or sympathomimetic excess.¹ No specific antidote exists—seek emergency care, with supportive treatment like activated charcoal if recent ingestion.⁷ Safe upper limits are not exceeded beyond prescribed max (100 mg/day adults, 1.4 mg/kg children), but toxicity rises with higher doses.¹ Store securely to prevent accidental overdose, especially in children.

Disclaimer

The information provided in this document is for educational purposes only and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.