Everything you wanted to know about Strattera

[Mayleng]

I can take it out, you know you can modify your posts here at Millermoms. Just click the modify icon.

[TerryB]

redfaun,
We have the max dose of Strattera that our doctor will Rx for her weight of 55 pounds. She is on 43 mg. She was on 40 mg when we noticed that it wasn't doing enough. The doc said going from 40 mg to 43 wouldn't do any good. I guess he was right. We are on a low dose of Daytrana, the stimulant. Everyone I have heard from is on a dose of Strattera that is at the upper limit. The stimulant dose is lower. I do understand how you feel about having so many different meds in your child's body. For us there was no choice because a normal dose of stimulants caused terrible side effects. Having two chemicals was safer than having one. You still have a chance of using just stimulants. It sometimes takes a long time to work out what is best for you. Lots of trial and error sometimes.

By the way, my dd's doc makes med changes over the phone all the time. He doesn't insist on seeing us between our 3 mos visits. A little tiny change in a medication doesn't require a visit. I would try doing it over the phone. It doesn't hurt to try. You sound like you are desperate for help. All they can do is say "no." Also, insist on leaving a message for the doctor if you run into one of those controlling nurses that tell you "no" right off the bat. Who cares if they think you are pushy. You won't been going there soon anyway.

[redfaun]

Mayleng, what stim is your son currently on? I know I've read it somewhere before but don't have time to re-read every entry. How is that med working for him? What was your experiences with other stims? Just curious as I consider the near future. And yes, I agree that we will just need to wait until March 24 and see what the new doctor says. Thanks for your input.

[redfaun]

Terry, Thanks for the advice and your history with the meds. I appreciate it very much. I'm certainly not at the desprate stage yet but could get there if things were to worsen before our appointment with the new dr. We have not been to the old doctor in over 6 months. When we had our last appointment in September, we ended up cancelling it because when we got to the office, there was a 3 hour backup (not unusual.) We tried to hang out for a while hoping that we would get in sooner but my son and I were sitting in a small room with a bunch of adults that had severe mental problems and on top of that, they were angry and frustrated because of the long wait. I finally had enough becuase my son didn't deserve to sit in such a hostle environment like that, so I cancelled the appointment (which was the only appt. that my new insurance would cover to that dr) and left. It was just terrible. So, I know for a fact, the old doctor will NOT do anything for us without an appointment. I've had this appointment with the new doctor set up since the end of Sept. Crazy, isn't it? When it comes to dealing with these phycholigist, I am frustrated. At least I know that the new doctor is for children specifically. Thank goodness for that!

[TerryB]

Sounds like you doooo need a new doc!!!!!!!!! Good luck.

[Mayleng]

redfaun, my 12 yr old has been on Metadate CD for the last 3 plus years and doing extremely well. We tried Adderall and Adderall Xr - great on his attention but he has appetite, sleep and anger issues, Concerta - did nothing for his attention by gave him sleep & appetite issues, strattera for 9 months - was not as good on as attention as on stimulants, and he developed a dry cough and would throw up at least twice a month and sometimes have problem urinating. We tried ritalin and ritalin la which was good for his attention, but he had sleep & appetite issues. Finally tried Metadate CD, works for his attention with no side effects. He has been on 30mgs metadate cd for the last 3 years.

As you can tell, you need to try the different meds to find the right one at the right dose. It is so worthwhile when you can find one without side efforts and it works. We have not tried Focalin XR or daytrana or vyvanse.

[TerryB]

In my experience, I can't always get what I want from the doctor but if I research the issues, I can ask intelligent questions so that you and your doctor make the best decision for your child. There are many ways to handle your situation. I think it is wonderful that you have options!

[nimsmum]

Our younger boy, 14, has been on Strattera for about a year now I think. Recently he seemed to be far less focused & mentioned to us that he was having difficulty again. I asked the doctor if we could try a larger dose as he had gained a bit of weight & was not on the highest dose he could be on. We tried him on an extra 10mg & he notices the difference. My question is, having read lots of posts on here, how can you tell if it is being as effective as posible? He has only tried Strattera & we noticed an improvement, but I still have a lingering query in my mind, is this everything we can expect from meds? He has ADHD innatentive, so there is no hyperactivity to notice. It all seems very subjective & confusing.

[lindab]

Don't know if Strattera is the problem, the dosage is the problem, or a little of both. My dd (age 8) was diagnosed last summer with anxiety, depression, and ADHD. Thanks to our HMO runaround, it took switching primary care docs to get us to a board certified child/adolescent psychiatrist, and delayed getting her started on meds until early November. My daughter weighs 52 lbs. and the doc started her on 18 mgs/day. According to the formula you state for calculated optimal dosage, she should be on about 28 mgs/day. The Dr. has never increased her dosage.

Initially, her moods improved and she definitely was much more on task with completing her homework. She has made straight A's this entire school year, which may be why the doc thinks that this dosage is enough for her. However, she was absolutely miserable in first grade and still pulled straight A's, so I don't think her grades are necessarily the right benchmark to use. She just happens to be very bright (tested at a mid-seventh grade reading level before entering 2nd grade).

Over the past month her moods have been awful - lots of lashing out at her sister, irrationally arguing with me about everything, crying hysterically about small things, having trouble going to sleep and then waking in the middle of the night... She has also been refusing to take her meds at all on some days because she says "why bother - it hasn't made me feel any better".

I don't know whether it's simply that her dosage is wrong, or if this medication simply isn't the right one for her??? I have an appointment with the doc in two days to discuss changing/adjusting meds.

You seem to have a vast store of knowledge about Strattera -- what do you think??

Sorry this post was so long...

[Mayleng]

linda, I would try bringing her to 30mgs to see if it helps with the moods before changing to a different one. Strattera is weight dependent. Use her current weight and do the calculation to see if 30mg is within her range.

[lindab]

Thanks - that's what I'll discuss with the doc. I'd like to give Strattera another shot before giving up. If we're going to start messing around with other meds, I'd rather do it during the summer break.

[ccgirl]

WE have been using 1200-1400 mg of Omega 3 fish oil. WORKS LIKE A CHARM...But I will keep in mind all this info on this drug. Apparantly there are some studies to see how it affects Dyslexic kids too

[mandmsmom]

My son who is 8 diagnosed adhd last Dec switched from adderall xr to strattera. We were starting to see rebound in the afternoon and serious appetite problems. He lost 6 lbs that he couldnt gain back so we are trying strattera.What a difference ! 8 days in and improvement is noticeable , always hungry still a little hyper but no more explosions at his sister. Thanks for all the info provided on this drug . I am hopeful grade 4 will be much improved in september !

[Mayleng]

I hope strattera continues to work for you son, and you see lots of improvement.

[Babs]

I love this thread! I'm starting Stratterra today and I need to be very alert at work. I was very worried about the lethargy issue and it was great to be able to come here and see that yes, I could take it at night until my system adjusts.

Thanks Mayleng!

[Mayleng]

Goodluck Babs. Let us know how it goes.

[csimmons]

I see this post is kind of older, but I had a question about Strattera and was hoping someone could weigh in.

I have a 5 yr old daughter who has been diagnosed with adhd, mood disorder, and ODD. She CANNOT take any kind of stimulant as it causes her to go into a horrible bipolar mood swing. She was started on Strattera (18 mg) in August. I do think it has helped a bit but it seemed as though it was "wearing off" around mid-afternoon. The Dr upped the 18mg to 25 mg and it seemed to make her much worse (horrible tantrums, aggression, destructive, etc.). He put the dosage back to 18mg and added 10mg in the early afternoon. Pretty much same thing. The horrible tantrums came back. It was horrible. In both instances of increase, we did not give it 6 weeks. But my question is this ... With ALL medications, at about 1 hr after taking the meds in the morning, it has a very negative effect on her. She will rage, tantrum, curse, etc... for about 30 minutes. We have noticed this since she was first started on meds. She is very med sensitive and we've tried about 15 different medications to control her symptoms. Does any of your children have this problem? The only meds she takes in the morning is the Strattera and Cingulair. I've thought about giving her the Strattera at night but I just wonder if it will last through the day. I really don't want to give her a mid-day dose because it will cause that same reaction. Your thoughts please?

[d]

csimmons.

I wish ohmama was around for this. Were any of the 15 meds you tried for BP/MD/ODD? Could she tolerate any of them?

The experience here has been ADHD meds can be used on BP kids but there is a big fat extremely important IF caution in there - that is the BP/MD/ODD has to be treated and in control first & foremost. In fact the ADHD becomes secondary to BP treatment.

Jisp would be good here too.

Five is a very tender age.

[Mayleng]

csimmons, strattera is counter indicated for mood disorders especially bipolar. It will pretty much trigger what you are seeing. So she should not have been put on strattera especially when it was known that she had a mood disorder like BP.

This is the warning in their prescribing information:

Screening Patients for Bipolar Disorder
In general, particular care should be taken in treating ADHD in patients with comorbid bipolar disorder because of concern for
possible induction of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above
represent such a conversion is unknown. However, prior to initiating treatment with STRATTERA, patients with comorbid depressive
symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed
psychiatric history, including a family history of suicide, bipolar disorder, and depression

Read this thread about Bipolar Medications
millermom.proboards107.com/index.cgi?board=general&action=display&thread=1526

[csimmons]

D:

The 15 meds that she has tried has not helped. We have an appt tomorrow with her psych, who by the way, has told me to find another psych because he can't help her anymore. He recommended residential for her but we're not doing it. She's far too young and it would be devastating to her. I think the main problem is that the aggression and adhd have been the focus for the Dr. The very first medication she took when she was 3, was Tegretol. It did not help. The only other mood stabilizer she's been on was Depokote and it did not help. I am thinking of asking the Dr to try Lithium with her. It just scares me because of the toxicity issue. I am also going to request taking her off the Strattera. Yesterday morning she tantrumed for nearly an hour, my husband and I had to take turns restraining her until she was able to calm down. Then last night she had another one, but much shorter. She averages 2-3 tantrums / rages a day. There HAS to be a medication to help with this! I know during one of her hospitalizations they gave her Haldol when she was totally out of control. You'd think the Dr could at least give us something to use PRN. It's ruining our family, our marriage, and our lives. I know her true heart is to be obedient and loving, but when this bipolar takes over, she turns into a monster.

[d]

I so feel for you and your dd. Sometimes with residential treatment, it is the only way to find out the right meds and get them on a stable path. The problem is her age. You're going to be met with docs either inexperienced or reticent to put dx labels on her, then the med concerns bc of her young age.

There is a link here in the one of the reference sections below to find psychiatrists and/or docs who are qualified for treating BP in kids. I'd start there and see if it turns up anything. Dx'g and treating BP in kids is serious biz and there aren't that many psychiatrists qualified to do that even though they all have the same/similar credentials.

Have you checked out bpkids.org?

And yup, I'd be dumping that psych.

[d]

csimmons, here's the thread on BP doctor searches:

millermom.proboards107.com/index.cgi?board=track&action=display&thread=4782

[Mayleng]

csimmoms, where are you located? d is right check out www.bpkids.org. if you haven't already. Your doctor seem to be treating ADHD while BP is the more immediate problem, and all the meds that are used for adhd will trigger mania if you have BP. It sounds like that is what is happening now.

[karah44]

I have a question about dosage... We are trying strattera with our 9-year-old ADHD DS (son) after failing with 4 different stimulants (metadate, adderall, focalin, and focalin long-acting, all of which made DS have increasingly more anger outbursts). We have been on strattera for 12 days, the first 7 days at 10 mg, the next 5 days at 20 mg, now going to 30 mg. My son weighs about 74 pounds, so his minimum target is about 41 mg, though his pediatric psychiatrist says he doesn't generally dose above 40 and I know getting exactly 41 would be difficult! We are already seeing good results from the strattera (we are giving it to him right after dinner, which is about 45 minutes to an hour before bed). He has quieted down and been able to concentrate on homework and even during a cubscout meeting last night where they were learning how to play chess. My husband now thinks okay, we are getting benefits so we don't need to keep upping the dose. But I don't know... is it possible to get significant, lasting benefits at such a low dose (20 mg last night, which is probably about .6 mg/kg)? We started 30 mg tonight, but do we not need to go there or higher unless/until the benefits we've seen disappear (or other negative effects start to surface)? I'm very confused and appreciate any help. Thanks!

--Kara
Mom to 9-year-old with ADHD

[d]

Welcome karah44.

Strattera takes anywhere from 4-6 weeks (my doc used to say 8) to build up to therapeutic levels. That ramp up & med adjustment period has to happen. However, it is wonderful that you're seeing early positive benefits from it - bodes well that it will be a good med for your ds.

Mayleng is goddess re min/max ranges as it involves a math formula I can never remember.

[Mayleng]

Welcome, studies have found that there is a therapeutic dose. While ramping up, which is what you are doing now, you will see good and bad effects. The good effects does not last long if he is not on the right dose for him. From our experience, too low or too high a dose, you will see mood issues later.

40mgs to 60mgs is the optimal dosage range for your son. Right now, you are experiencing the "honeymoon" period. You could stay at 20mgs if you want until you see the benefits disappear or the mood issues arise, there is nothing that says you have to move up. BUT keep a very close eye on the mood issues. If you see it, then move up to the next level. Of course, discuss this with the doctor.

[karah44]

Thanks d and Mayleng! We start 40 mg today. So we should stay at 40 mg for 4-6 weeks then evaluate? What am I looking for at that point? How will I know if my son needs more than his minimum? I don't know that his doc will want to go to a higher dose, so if my son needs it, I will have to ask for it, and I will need something to back my request!

--Kara
Mom to 9-year-old with ADHD

[Mayleng]

Kara, yes keep him at 40mgs. Whether this is the right dose really depends on what his issues are and if you see improvements ie can maintain attention (if that is his problem), is less hyper/impulsive if these are his problems, if there is not side effects etc. You will have to be the judge of that.

Here's another site about strattera that might be of interest to you.

www.johnswank.com/Strattera.htm#Dosing

however, according to this study, there is not much difference in results using 1.2mg/kg/day and 1.8mg/kg/day.

pediatrics.aappublications.org/cgi/content/full/108/5/e83

here's one that went up to 2.0mg/kg/day

www.ncbi.nlm.nih.gov/pubmed/11642475?dopt=Abstract

[jenwm]

hi, my son started on 18mg strattera yesterday. He took his second dose after supper today. He takes the 18mg for 7 days then goes up to 40mg. He weighs 75lbs. I am giving it to him at night right now. When should I start giving it to him in the morning?

[Mayleng]

Try keeping him on nite time does for two weeks, and evaluate.