Everything you wanted to know about Strattera

[lilmiss]

I have an appointment with my son's doctor this afternoon. He has been on Strattera since last spring. It worked beautifully until the last month. Since then, he's been noticeably more active, talks nonstop and it takes more to get his attention for him to listen to instructions.

I weighed him and his weight is unchanged. He weighs 47 pounds and is on 30 mg. His doctor uses 1.4 mg, so he's several pounds away from an increased dosage. There are no other noticeable health problems or changes.

Do you have any suggestions on what I should ask his physician? I hate to have him on medication if it's not working. Strattera is the first med he's taken.

Has anyone else experienced this - when the med stops working and there's no other health things, such as allergies, going on?

Thanks!

[Mayleng]

We have heard from several parents that sometimes strattera just stops working. Is there a reason why the doctor used strattera as the first medication? Most would use stimulants as the results comes faster and there is less tweaking. Stimulants have been around much longer than strattera and there are several to choose from. So if one doesn't work, try the next one.

I suggest, your son either needs a dose increase of strattera to see if that would do the trick or if maybe a stimulant might work better.

[brenden]

Brenden's doctor gave him Depakote to help control the migraines. He told me not to stop the stattera because he didn't think that was what was causing the headachs. I think that Brenden does occationally vomit from the strattera because it is within a half hour after taking it and he feels better right away but it was never so often that I felt he should stop taking it. But now there are times when he vomits in the morning and continues to vomit throughout the day, sometimes with a headach and sometimes without. I have heard that some children that have migraines will have early morning vomiting without a headach, so thats why I'm not sure what to do. I just am so impressed in my sons improvement since starting strattera that I don't want to mess things up by taking him off of it. We tried many different things before we tried strattera and they all changed Brenden so much that I would have rather him be on nothing at all. I don't know if there are any other non stimulant meds out there he can take that are similar to this one. So maybe I should just wait for the meds to kick in to control the migraines and if he still is getting sick in the morning then talk to his doctor about stopping the stattera. Do you think that 60mg are to much for him, he weighs 65lbs?

Thank you

[Mayleng]

60mgs is on the high side. His range for 65 lbs should be minimum 35mgs and maximum 53mgs (or the closest mgs available 50mgs ie. two 25mg pills).

Hopefully, the Depakote will help the migraines. If that doesn't work, than chances are it might be strattera causing it.

[lilmiss]

We visited with my son's doctor yesterday. He suggested we give the Strattera another couple of weeks and it there is no change, we try a stimulant. We started with Strattera because the doctor indicated it might be more helpful in children that were exposed to alcohol.

My husband is very concerned and keeps saying he doesn't want my son on a stimulant if they can be addicting. I'm going to try to find some info that will explain them to him. I've also pointed out that the stimulants have been studied much longer than the Strattera.

My big concerns with stimulants are my son has always been small for his age and he's always had some difficulty in falling asleep. Also, I don't want a roller coaster effect in the afternoon when he's coming off the med. Strattera was nice and even (when it was working!).

How did you guys determine which stimulant to try first? Did you go off your doctor's recommendation?

[Mayleng]

It's pretty much what the doctor recommends, although I did my research, and took the lead in what meds I wanted to try. It really is a crap shoot which one would work for an individual child.

There is a study I just posted about stimulants and the long term academic benefits, you might want to print that out for your husband. Also there are lots of literature out on who at risk unmedicated ADHD kids are to alcohol and drugs as they tend to self-medicate. Stimulants is not addictive if taken correctly, if it were, I would not be able to take my son off it for the summer vacations and weekends. Trust me when I say, he does not have withdrawal problems.

[TerryB]

lilmis, sometimes I wonder if you could just add a few more mg of Strattera it would help when it stops working but you can't get tiny doses of Strattera to fine tune a dose. My dd is on Strattera and it is working pretty well. She really needs it for her anxiety as much as her ADD. Our next step will be to add a tiny bit of stimulant if needed. We'll see if this is needed. Time will tell.

[pep0652]

MY 7 yr old ds was started on Strattera a week ago. He took 25 mgs for 7 days and has now been on 40 mgs for 3 days. He's complaining right now that his stomach hurts and wants to stay home from school. I've read here that stomach pain is a side effect of Strattera, but how long does this usually last?

Thanks, Pep

[Mayleng]

Jumping from 25mgs to 40mgs is a big jump, and most kids cannot take that big a dose adjustment. That side effect would go away in time, how long depends on the kid. Make sure you give him the pills with food, and if this continues, try giving it to him at dinner time and let him sleep thru' the side effects. After a couple of weeks, then change to morning dosing.

By the way, what is his current weight?

[pep0652]

mayleng said:

Jumping from 25mgs to 40mgs is a big jump, and most kids cannot take that big a dose adjustment. That side effect would go away in time, how long depends on the kid. Make sure you give him the pills with food, and if this continues, try giving it to him at dinner time and let him sleep thru' the side effects. After a couple of weeks, then change to morning dosing.

By the way, what is his current weight?

Hi Mayleng, he appeared to not be having any side effects from the med at night time, so I tried giving it to him after a full breakfast. He did fine the first day, but the 2nd day started complaining of stomach pains. I went back to giving it to him after supper again and all has been fine again. Will give him a few more weeks to get used to the drug in his system and will try him on mornings again.

BTW, he is 51 lbs.

~ Pep

[Mayleng]

He is at the high end of his dosage range. Lowest 30mgs (approx) and highest 40mgs (approx).

[lilmiss]

We've decided to take my son off Strattera and try something else. There's no point in taking an RX when it doesn't seem to be doing anything now to curb his ADHD. We have an appointment on October 24 to discuss other medications. I asked the nurse if we could begin to taper off Strattera and she said to take it until the appointment and the doctor will then tell us to quit taking it and will prescribe something else. She said there is no tapering off, you just stop.

Have your children discontinued Strattera cold turkey? What side effects did they experience and how long did they last?

[Mayleng]

We stopped cold turkey, and did not have any side effects. It takes a while for the strattera to be totally out of the system.

[ptpmom]

Wow! Thanks Mayleng. That was amazing!! So far, I feel that I am getting no where with the Strattera. DS is 60lbs (61/2) and now being weaned off at 18mg. He went as high as 25 mg (at night) and oh---the restlessness at night. Maybe instead of taking him off, I should try it again in the morning. I will be asking his doc about this on Monday. His anger outburst are what are troubling us. Thank You!!

[msk385]

Hi my 8 year old is currently titrating up on Strattera. He is a big boy....57" tall and 95 lbs. So the doc started him on 18mgs for one week, 36 mgs week two, then finally 54 mgs week three. We just started dividing the dose (we are about to enter week three), since he had insomnia when we first started. Other than that, the only side effect has been intermittent sore throats, sometimes when he sleeps. Others during the day...he sometimes has sinus issues, and we had the doctor check for strep...since he gets that 2 - 3 times a year. Negative test.

I read that sore throat can be a rare side effect of this medicine. Does that indicate anything else? Neuroligist thought that sore throat can be caused by GERD from the Strattera. He never really had anyone with that side effect he says, and this guy wrote a book on this stuff. How long do Strattera side effects last? And finally, do we wait for real results 4 to 6 weeks from the 56MG. Any insight is greatly appreciated.

Thanks,

Mark

[TerryB]

I don't recall how long side effects lasted but it was a few weeks longer than the standard time reported.

[swmom]

Hi Mark -

We're sort of unusual in the way deal with Strattera because my dd, 116 lbs., metabolizes medicines very quickly, but it works for us, unless:
1. She's sick or getting sick
2. Really, really tired or stressed
3. If she's on the wrong dose

As you know, Strattera is weight dependent so it is important to be on just the right amount or else you will continue to see side effects. My daughter's weight tends to fluctuate, 2 lbs.up then 2 lbs. down. This slight increase and decrease throws off the med's effectiveness, really. But that's us. Hopefully others will respond to post, too.

Also, most kids can one big dose of Strattera in the a.m. and it works throughout the day. For us, we have to be on 3 doses a day because it wears off.

Also, we saw positive effects from Strattera after just a few days on the meds. We weren't on it for 6 weeks before we saw it results. It was much, much sooner.



3.

[Mayleng]

Generally you would wait the 4 to 6 weeks on Target dose (are you shooting for 54mgs or 56mgs?) to see consistent results and any ebbing of side effects.

My son, however, had a dry cough the entire 9 months he was on strattera, and also he would throw up about once or twice a month. This did not go away for him.

So we decided to stop strattera since it did not help his attention as much as the stimulants.

[msk385]

Thanks to everyone. No throwing up, he eats us out of house and home. Any emotional volatitily we had seen, is now gone. The kid is in an extraordinarily good mood. So we are keeping our fingers crossed, since he could only tolerate 10m of metadate CD, and Adderrall XR was a disaster.

[msk385]

oops 54MG is what we are shooting for

[TerryB]

Mark,
We were not successful with stimulants because of side-effects. Strattera might work at 70% compared to the attention that we got with the stimulants. The difference is in the mood. We have a happy child now. We don't care if she isn't attending 100% so long as her grades are good and she is not distressed by her ADD symptoms. There is a possibility that we may have to add on a small dosage of a stimulant at some point but so far we see K continueing to find tools to work around her disorganization and forgetfulness. So many kids don't even care to be organized and do well in school (6th grade) that dd can beat their standards. Granted, we are fortunate that dd doesn't have any learning disabilities.

[laxmom]

My eldest son took Strattera for almost 7 months when he started to getting horrible stomache aches. We decided to try Concerta. He has been taking Concerta for almost 3 years now.We have adjusted the dose each year.He is in High School and doing great!

[redfaun]

Been on Strattera since March of 2005 - my dd was in 1st grade. Was used for both attention problems & hyperactivity. He's now in 4th grade. Started off the year good but we have notice on his last report card a trend of "experiencing difficulty getting work completed on time". This was mentioned on the note part of his card on almost every subject, except P.E. (ha ha). We've seen a terribly distracted child at home with his homework and anything that requires him to pay attention (if it's not interesting to him). Doesn't seem to have the hyperactivity anymore, just hightly distracatble. It's frustrating him. He admits to having trouble paying attention on independent work in class, which gets him behind and then he needs to finish the classwork as extra homework. He weigh 55 lbs and is on 40 mg of Strattera. We have an appointment with a new doctor (required by new insurance company) scheduled for March 24. I think I have read before that Strattera seems to have a history of wearing out, especially with the distractability issue. Am I right on this? He's never taken stims. I feel so sorry for him. Last night he wasted two hours doing "nothing" at the table instead of just "getting it done". Instead of getting his homework done in 1 hour, it took him three. Then he was angry/sad when he realized what he had done and that he missed out on playing with friends outside. He doesn't seem to have the ability of focus whatsoever on anything that is not interesting to him.

[TerryB]

You do have options. My dd is on Strattera and a small dose of Daytrana. She had side-effects with stimulants alone. The lower dose allowed by the underlying Strattera has limited the side-effects of the Daytrana. Since you have never tried Stimulants, you could stop the Strattera and try stims. My dd is also 55 pounds and her dose of Strattera is 43 mg. That's the maximum for her weight. It is unusual to start out with Strattera before stims. The stims usually work better. Was there a particular reason why your doctor avoided stims such as a comorbid like OCD or anxiety?

[jw]

Hi redfaun,
It seems like a lot of people who have had success with Strattera have been adding a small dose of stimulants if they run into a problem like this - it might be worth trying for your son, since you have had good results for so long with it. Good luck with the new doctor - it seems like they all have their favorite medicines, so it will be interesting to see what he will suggest. In the meantime, is there any chance your current doctor will prescribe the stim to get you through the next few weeks? If not, maybe your teacher will let you modify the homework and classwork - let him do enough to show mastery of the material rather than getting overloaded and exhausted by working so long after school (we did that in 4th grade, and it wasn't fun!). Good luck, jw

[Mayleng]

First I would try bumping up strattera to 45mgs (if you can) and see if it improves. A few people have found that after a few years, it seems strattera stops working.

If that does not work, before doing a combo of strattera and stimulants, I would just try stims on it's own unless he has cormobid issues that stims would aggravate. No point doing two meds when only one is necessary.

There are various stimulants you can try.

[TerryB]

After reading jw and Mayleng's responses I would probably consider upping the Strattera first. This is what we did but it wasn't enough for my dd. We went from 40 to 43 mg. The doctor wouldn't go higher with it. If you still don't have the focus, you could consider adding a low-dose stim. Since you are all ramped up with the Strattera (you know how long that took), you could add a stimulant to at least see how the combo works for you. Giving up the Strattera might give you some unpleasant surprises in the evening and the morning when the stimulants are not effective. Then you at least know what the Strattera/stim comb. will do for you. If you are not happy with the combo or if you really want to go down to one med, you could then go onto to step three which would be to drop the Strattera and try a stimulant alone. If you drop the Strattera right away, use a stimulant and are not happy, then you will have to take a couple months to ramp back up on the Strattera before you can add a low dose stimulant to the Strattera. Some kids can tolerate a little stimulant but not a full dose.

[redfaun]

Wow! What a response! First off, thanks for the recommendations. 2nd, I am sure that we won't be able to make any changes to his Rx until our appointment with the new doctor. His current doctor is difficult to get a a quick appointment with. I am hopeful that his new dr will be more available. The 1st doctor went directly to Strattera becuase he wanted to try the the non-stim medication 1st and for the most part, it did the trick. But not now, I suspect. How does the combo work? Sounds like it's a lower dose of Strattera? I always fear that so many different meds in a childs body is not an altogether good thing? Makes me a bit nervous and I'm sure my husband would be concerned too. I am sending my son's teacher an e-mail today to communicate our concerns about his lack of focus & about our appointment w/new dr on 3/24. At least she will be aware of what we are seeing at home. Mayleng, I would consider upping him 5 mg to 45 mg, but I don't think we have any 5 mg tablets left and I know the old Dr. will not prescrible anything w/o seeing him first (which won't happen because you have to make an appontment over a month a head of time - he's only in my part of San Diego once a week!) I'm just glad to see that I'm not alone and this seems to be a common problem with the Strattera. Too bad since the Strattera has been working fine for the past 2.5 years. Good thing is that the week of 3/24 is his spring break so if we were to start a new med, we'll have some time to see it in action before school starts again on 3/31.

[redfaun]

Hey, I did not intend to put that "you rock" figure in there! Geeze...

[Mayleng]

If you raise it to 45mgs, you are going to have to go one 25mg and two 10mgs to make up 45mgs since strattera does not come in 5mg doses.

Unfortunately, I think you have to wait till you see the new doctor to change or discuss the meds. My son did the strattera/stims (adderall xr, concerta, ritalin la) combo, and non worked as well as just being on stimulants. He is predominantly inattentive.

So if upping the strattera doesn't work, and if there is no other reason why not to put your child on stims, I would rather just use one medication. Even if you decide to go back to strattera and a combo, his ramp up won't have to be as slow as when he first started because his body is used to it. You could do a quick ramp up if you had to.