Everything you wanted to know about Strattera

[Mayleng]

An Audio postcard from Dr. Handelman on Strattera and suicidal thoughts.

members.audiogenerator.com/postcard/?3108104X1166

[joemegmom]

Mayleng,
Do you have the audio postcard about Adderall? In the Strattera post card Dr. Handelman said he did one similar about adderall. I signed up for these audio postcards but I would love to hear the older ones. Could you post them?

[Mayleng]

Sorry, I can't seem the find the one for Adderall. Here's a link about the safety concerns over stimulants etc. he mentions Adderall XR in it I think.

www.theadhddoctor.com/fda/

[VaMom]

mayleng said:

An Audio postcard from Dr. Handelman on Strattera and suicidal thoughts.

members.audiogenerator.com/postcard/?3108104X1166

I listened to that yesterday. Getting the details was very reassuring. Anyone who wants to know exactly what the situation was with the warning on Strattera should listen to it.

[jw]

Hi! We had a visit to my son's child psych today and he made an intersting comment about his experience with Strattera - he said that he has noticed that it has not been as effective for inattention in the long-term as it has been for impulse control or hyperactivity. This may already be in the thread, but it was news to me and helped explain why my son stares off into space more and more as time goes by! We had really good results for most of year, but the effects have started to wear off....

JW

[Beverly]

Interesting-my son's doc had said just the opposite when he was on it-that it helped with unattentiveness but not impulsivity!!

[Mayleng]

I think the doctors don't know what they are talking about. It is probably from their own experience with their own patients and as we know they all react differently to the meds. It is a very individual thing.
All things considered, strattera is very new on the market compared to the rest of the ADHD meds, so we are still learning things about it as we get more experience.

That being said, my ADD/INattentive son was on it for 9 months, and it never quite got his attention to the point where the stimulants have.

[sportsmom]

My son has been off strattera for 9-10 months now. All of a sudden when he had a urine test in June he had high levels of protein. After 2 months I finally got another sample in and it still has high levels. After doing some research I am finding that high protein count and kidney problems go hand in hand. Anyways I was wondering if anyone knew if strattera has any adverse side affects on the kidneys? I have been reading about when patients first start taking strattera they have a better luck urinating then before? Is this from the kidneys or the bladder(from the strattera use)?? Any thoughts would be appreciated. Thanks!

[jw]

Hi! I checked the patient info for Strattera, and didn't see anything about kidney problems except that Strattera can cause urinary retention and urinary hesitancy (my neighbor's son had problems with this when he was taking Strattera). I think many of the meds can cause higher blood pressure, which over time can have a negative effect on the kidneys - is his blood pressure OK? Hope everything works out for you and your son! JW

[Mayleng]

There is a warning about the Liver with strattera, but not the kidney. After being off for so many months I doubt that strattera is the cause. Is he on other meds right now?

[kris65]

Hi Everyone! My name is Kris and this is my first post on this site. I can't tell you how happy I was to find this forum yesterday! I do frequent other sites but no one seems to have too many stories concerning Strattera and that is why I'm here. My 10 year old ADHD son has been dx for 4 years now. We have tried Adderall, (nightmare! Very emotional and unhappy), Ritalin LA (worked great for about a year and just pooped out), and Concerta (Worked excellent for about 2 years and then stopped being effective even at higher doses). So here we are. He has anxiety issues that we have been treating with Rispedal for about 6 months now. He takes a very low dose (25mg at night) and it seems to take the edge off. He is 10 and weighs 108 pds. He gained 20 pounds since he started the Rispedal. Anyway, his psychiatrist has been wanting him to try Strattera for some time now. I refused due to the side effects but just recently agreed because the other stims weren't working and we needed to find something to help him at school. So this is my problem. We started him out on 18mgs. The first 4 days seemed to be ok. No side effects except a little tired. On day five, he got a very bad migraine and started to vomit. I called the doctor and she not to ramp him up to the 25 (witch was suppose to happen the next day) and give him the 18mg for a few more days. We did that and he didn't get another bad headache, but he was having stomaches quite frequently. So we went up to 25mg and the stomache pains continued and I noticed that he was very distant one mintue and hyper the next. Then everyday about 1 hour after I would give him the meds he would get very hyper. Not a little, very hyper. Then he would get a little agressive. Not hurting anyone, just tense. So I called his doctor, she said that she thought that the 25mg was too much and to go back down to the 18mgs. So thats where we are at now. She told me to skip a day and let the 25mgs get out of his system and start back on the 18mg tomarrow. It has been almost 3 weeks since we started this process and I don't know if I can stick it out. Today he had no meds and it was his first day of school. He seemed to do ok, but I know he can't get through school without any meds. He was so happy today, not tired, or moody, and no headaches or stomache problems. So after reading this whole thread I either get the feeling that we did not ramp up this medication properly, or that he just can't take it. He never had these kind of side effect with the stims. I don't know what to do! Should I just give up before the 4 weeks or stick it out? I'm so sorry this is so long. I'm really at a loss. Any comments would be truly appreciated! Thanks.

[Mayleng]

Welcome, If you read the first post on this thread, you will get to know the ins and outs of strattera and what to expect, how much is his dose etc.

This medication is very weight dependent and does need to be ramp up. For some kids there will be initial side effects, being on too low a dose can also cause mood issues. To reduce the side effects, it is better to give the meds in the evening, so he sleeps thru' the side effects, until he reaches his target dose and have been on it for 4 weeks or so. Once there is no side effects, then change the dosing to morning.

Ok, that being said for his weight, his target range should be
minimum dose 60mgs and max. 90 mgs.

So being on 18mgs is way way below his target range.

What you could do (if your doctor agrees) is change to nite dosing, give him the meds with dinner. Increase to 25mgs and stay on that for 4 days or so, then increase slowly to 30mgs for another 3 to 4 days, then 40mgs for another 3 to 4 days, then 50mgs for 3 to 4 days, then 60mgs which is his minimum target dose. You are going to need a mix of dosages to do this ie. alot of 10mgs pills to make up smaller incremental dosages. Rather than stay on the standard available dose longer ie. 18mg, 25mg, 40mg and 60mgs - I think the side effects are lessened when the incremental dosages are less of a jump like 25mgs to 40mgs. Most kids get into trouble with that big an increase. Once you get to 60mgs stay on it for a while ie. 4 weeks and see if it is consistent and effective if not, go to 65mgs etc to a maximum of 90 mgs if necessary - I wouldn't go any higher.

I don't know how Risperdal interacts with strattera though. You might want to ask the doctor about that.

Good Luck.

If you decide if strattera is not right for your child. You could always try Metadate CD or Focalin XR to see if these might work.

[kris65]

Hi Mayleng

Thanks for the response. My son is 10 years old and weighs 108 pounds. His doc wanted him to get up to 60mgs. What concerned me was when he started to have side effects at 18mgs, and even more at 25mgs, what would we get at 40? She wants him to go back down to 18mgs. It just doesn't sound right to me. After reading this thread, it sounds even more strange.

[Mayleng]

Oops, I was correcting my post when you posted in respond to it. Read my post again. It has some suggestion.

[mariaven]

Mayleng:
I read your post (the first one of this subject) and I got some answers I was waiting for. I am very proud of me with the fact that I was really patient waiting for the strattera effect in my son; it took about 8 weeks to kick in. He started in a very low dose (10mg) for about a month taken at night and then switched to 18mg taken in the morning; now I know that my son's doc (a children's neurologist) is very well informed on how to start administering the doses. My son weights 22kg(about 50ponds I suppose), he is 6 yrs old and very skinny. Now, according to all you say in your post it is obvious that this med is doing wonders for my son in school hours because when he comes back home (not every day but many times), he comes angry and completely opposed to do homework, so it is normal that I usually have fights with him over homework issues. On the other hand I am really glad to say that last week I had a meeting with one of his teachers and she told me that if I hadn't told her that my son had adhd she wouldn't have noticed it; this comment made me a happy mom because it seems that this school year I will live a completely different story. To my amazement he even won a best student medal the third week of class. This also gives me some clues on the questions I will ask the doctor on my son next appointment at the end of November.

I am very curious about the twice a day dose because what is probably happening is that the 18mg dose wears off after school time ( I thought that strattera was supposed to work for all 24 hours). I really get very discouraged when I see that at home he doesn't show a lot of difference in adhd symptoms; of course there is a difference in a few things but I tell you again that it takes me a lot of work to deal with homework and study spelling words, he doesn't want to concentrate at home but after fighting and making me upset he learns them and comes back from school with an A+. I really want to see some improvement at home too.

I also started trying natural alternatives, this is how I found this forum. So let's see if the omega, magnesium, and vit E work out in improving home situation. I know that they also take time to work.

Thanks for all information and I am really happy I found you.
P.D: As an extra I would like to say that my native language is not English, so excuse me if my writing seems difficult to understand at times.

[Mayleng]

mariaven, your English is fine.

It would seem to me that your current dosage of 18mgs is low for your son's weight. Since his weight is already in kilograms, all you do to find the right dosage range is take is weight (in kilo) and multiply by 1.2 for the minimum dose and multiply by 1.8 for the maximum dose.

So his minimum dose at 22 kg is 27mgs and maximum dose is 40mgs. Somewhere between the minimum and maxmimum is the right dose for him.

The thing with strattera is too low or too high and you will end up with mood issues. So instead of sticking to 18mgs try raising to 25mgs (which is the closest available dosage to 27mgs). Strattera is a 24 hour med, the reason it doesn't lasts 24 hours for your son could be his current dose is below his weight dependent dosage . Try raising to 25mgs and see if you see improvements. The good news is at 18mgs he is doing well in school, so you might have good luck with 25mgs. But as he grows you might have to adjusts the dosage since strattera is weight dependent.

[VaMom]

Hi Mariaven,

My son has been on Strattera for a long time now. In addition to all the good info. you've gotten, I want to point out that while yes, Strattera is supposed to be 24 hours, it is not 24 hours of equal coverage.

Strattera actually has a half-life of just over 5 hours. That means if your son takes it at 8 a.m., it will be peaking in his system at 1 p.m. By about 6 p.m., Strattera will be down to about 25 percent effectiveness. By the 23rd hour, it will be down to about nothing. So part of the 24-hour period, Strattera is at trace in the bloodstream, and medications are typically not working when they are at trace.

I agree that you should slowly raise his dose. Slowly and cautiously. Welcome to the boards, this is the best place on the Internet, thanks to our outstanding administrators and wonderful supportive members.

[my2angels9398]

After reading everything that you wrote about Strattera, I am highly concerned that my sons' doctor has him on too high of a dose, and wanted others imput.> I called a specialist after reading the post, to see about getting a second opinion from someone who specializes in ADHD, but the earliest he'll get in is April (UGH!) And I have a call out to his doctor who prescribed the med.
Okay so here goes, my son just turned 8 years old and when he was weighed last week he weighed 51 pounds, when he was started on Strattera 3 weeks ago, the doctor started him on 25 mg for 7 days then increased it to 40mg, and that is what he has been taking since. He never said about giving it at night, he's always taken it with his breakfast in the morning. We don't see any real change in his activity level, but we do notice that it helps with his school work*(due to the fact that he went off for 1 week because he doesn't like taking meds) and his schoolwork was horrendous. Now that he is back on Strattera he is doing much better in that area, but I'm still concerned that maybe his dose should be lower, especially after doing the math..

Any help or suggestions would be great. I want to be helping my child not harming him..

[Mayleng]

For 51 pounds his dosage range is 27mgs to 41mgs. So he is at his maximum at 40mgs. If he is doing well on it, I wouldn't be too concerned. Is he having any side effects?

The reason you would give it at nite is if he had side effects during the ramping up period. What your doctor did was ramping him up really fast. If he does not have any side effects, ie. sleepiness, tiredness, stomach upsets, moodiness etc, then he is very lucky.

It would take 4 to 6 weeks on target dose (in this case somewhere between 27mgs and 40mgs) to see consistent results. So 40mgs is OK for him unless you see side effects, on too high you may see anger issues. It is good news that you see improvement in school work.

[Mayleng]

my2angels,

I posted this response to you under the other thread you posted introducing yourself.
Since you did not mention the Tics here, I thought I better repost it over here so people get a complete picture.

You did not mention the Tics. If he did not have tics before, chances are the meds may be causing it, I wouldn't jump to Tourettes that fast. The 40mgs he is taking is his maximum and still within his range, however, it might be too high for him, you might want to reduce it to 30mgs or 35mgs and see if the Tics stop.

Strattera is a tough med to figure out and manage, and also takes a while to see results. Your doctor started him on too high and then ramped up too fast.

Anyway, have you considered trying Metadate CD? My son who is ADHD/In also saw anger with Adderall Xr and Concerta did nothing for him except give him side effects. He was also on strattera but the improvement on his attention was never enough for school. He is currently on Metadate CD now and it has been the best for him. Metadate Cd lasts 8 hours like Ritalin LA and Focalin Xr. So you might want to give these meds a try if Strattera is causing your son to tic.

[mariaven]

Mayleng
Your last post in which you mention the tics calls my attention because my son was actually put on strattera due to his tics. His neurologist told me that he normally prefers to start treatment for adhd with Ritalin but in the case of my son this was out of the question because he has tic periods. Before I took my son to this doctor I was very concerned because I thought that he would probably be a Tourettes case; fortunately the doc said that my son does not comply with all the criteria for Tourettes. At the beginning of taking strattera I was very enthusiastic; he was showing some of the side effects but they were going away just as expected. Since the beginning of school year the teachers have told me that he was progressing normally just as the other kids. These last days I am starting to feel somewhat discouraged because as school demands are getting more difficult, my son comes home upset and opposed for homework and spelling words. I know that is probably due to the dose, as you said it could be too low. His next doctor's appointment is for the last days of November. I don't know if try to move the appointment earlier and go like crazy saying that strattera is not working, or give it more time. I am terribly scared about taking the decision by myself and buying a higher dose( 25mg). On the other hand I am also afraid that Strattera might not be the med the will help my son with his adhd because apparently I don't have more choices due to his tics.

Thanks for reading my long novel. Any comment or suggestion will be appreciated.

[Mayleng]

Ok, now I understand. It is difficult to use stimulants if he is prone to tics. Is your son on 40mgs now or 25mgs? If he was on 40mgs I would wait out the 4 to 6 weeks and see if the results is consistent.

Another thing is have you ever had your child evaluated for any Learning Disabilities. With ADHD comes a higher percentage of Cormobidity with learning disabilities.

[mariaven]

Mayleng:
My son is currently taking 18mg. He started with 10mg for a trial period and then switched to 18mg. He has been on that dose for about three months. After waiting some weeks I started noticing some positive aspects about his behavior like sitting still and eating quietly, but I was not really convinced that it was helping right in the academic issues eventhough the teacher told me that he was just fine. The real problem apparently comes when he gets home.

Before he was dignosed he went through multiple tests; medical and psychological. It took us about two months to get his result. He was even tested by two different psychologists at the same time to see if they got the same diagnosis. He was also tested for thyriod and the result was fine. Psychologists told me that his intelligence was the one that would be expected for his age.

Apart from taking strattera, he is on psychological therapy and also attends a private tutor who is helping him with school matters. Just yesterday this tutor told me that she was noticing that my son seems to be more active; he has body movements more than before. I talked to her about my concerns and she suggested me to wait some time saying that everybody has good days as well as bad days. I don't really know if to wait? Something is telling me that this med is not helping.

In regard to a learning disability, I thought that adhd is a learning disability itself. Maybe I am not informed about this. But I can say that my son's neurologist who specializes in children is an old and very experienced man; I think I did my job in finding him, actually he is the best one here in my country, I can't tell you the trip I have to make for each appointment. So if another learning disability is my son's case, I think that he would have said it for sure. His diagnosis was: Attention Deficit Hyperactive Disorder combined with simple tics.

Honestly I am really trying to give my son everything I can so he can be a happy child. Each time he comes angry from school and spends all afternoon upset and opposed to everything I say it kills me. I feel so tired of dealing with this,; I usually end my day with migranes; this affects me so much!!. Writing here is a way to vent and feel support from people who is dealing with similar issues.

Thanks for your replies and support!!!

[Mayleng]

Ok, I was confused between you and my2angels posts.

If your son is only on 18mgs, then he is below his target dose and you won't see consistent results until he has been on target for 4 to 6 weeks. You need to call the doctor and see if you can raise his dose to 25mgs. You would normally increase the dosage slowly (small increases every few days). So from 18mgs, his next available dosage is either two 10mgs pills or one 25mg pill. Strattera is weight dependent, so being too low is going to give you mood issues as well and will not be effective. You need to bring him up to between 27mgs and 40mgs for him to be in his target zone. Since he does suffer from tics, I think you should increase slowly. So if you have left over 10mgs pills, then give him two of them a day that would bring him up to 20mgs. Then after a week, bring him up to 25mgs and see how he does.
But please talk to your doctor about this.

Remember, he needs to be on his target dose for 4 to 6 weeks before you can see consistent results. So don't give up.

[mariaven]

Thanks, I will definitely talk to his doctor. I will keep you posted on his progess.

[momw3kids]

HI. I am new to this site. My son who is 6 just started strattera a little over a month ago. Last year we tried concerta and focalin which both did not work only aggravating his adhd more.
So i really gave up on him being adhd and concentrated on his sleep apnea more. His 10 year old sister and my husband have adhd too ---my daughter is on concerta and it works for her!!!
He has behavior problems the most, besides hyperactive, etc. The strattera seemed to work right away ----we have not had any problems with behavior ----- and that was a big problem at school and summer camp for the last 2 years. He has almost been kicked out of both. I hope the strattera continues to help. His teacher and guidance counselr (and principal) are very happy with him!!!! Yah!!!! WE do also go to childrens specialized hospital for outpatient therapy!!!!!!!!!! I have tried many things to help him, strattera has been a miracle. I say this with my fingers crossed. He is about 57 lbs and takes 10 mg in the am and 10mg at school later in the day!!!!

[Mayleng]

momw3kids. I see you moved your post over to the right thread.

[momw3kids]

Yes, I moved it, I guess after I register in I did not look at the entire posting for the meds. Thanks for letting me know!!!! I am glad I heard about this forum ---- it is nice to hear from others about their experiences vs my own with my kids!!!! Thanks for the welcome!!!!

[VaMom]

Hi momw3kids,

glad to hear about the success on Strattera. My son has been taking it for about 3 and half years now. Right now your son is below his target dose. At his weight, his target dose is betweeen 30 and 46 mgs. That doesn't mean you need to change anything, but if you should see the med. not working, know that you have a LOT of room for increase, example, you could do an 18 twice a day instead of a 10. Best of luck to you and yours.

[jellyben]

I am so glad I found this website! My 9yo DS started Stattera 6 weeks ago at 25mg, and has been on 50mg for 5 weeks. We have yet to see any noticeable improvement. His child psych initially wanted him on 75mg but we decided to stay at 50mg because of some concerns about his mood and behavior.(Although his mood and behavior were major issues before the drug and don't seem worse to me since starting the drug)

For a 66lb boy, is 75mg even safe? From everything I have read and in talking to friends with experience with this drug, it is too high for his weight. But the doc says in his experience 40 or 50mg isn't effective. We will give the 50mg a few more weeks to take effect, but after that must decide if we should up the dose or try another med(we tried Concerta 2 years ago for a week, but it kept him up until midnight and did nothing for his ADHD symptoms.)

I should add he is also dx'd with depression, which we are treating with therapy for the time being.

Thanks so much!