Everything you wanted to know about Strattera

[Mayleng]

Good Luck, and let us know how it goes.

[Mayleng]

New warning on Strattera:

WARNINGS
Serious Cardiovascular Events
Sudden Death and Pre-Existing Structural Cardiac Abnormalities or Other Serious Heart Problems
Children and Adolescents
Adults
Assessing Cardiovascular Status in Patients Being Treated with Atomoxetine
Emergence of New Psychotic or Manic Symptoms
MEDICATION GUIDE

What should I tell my doctor before taking Strattera?
Other important safety information about Strattera

[Mayleng]

Interesting study:

millermom.proboards107.com/index.cgi?action=display&board=general&thread=1168610461&page=1

[swmom]

Dd, 12, who is now 5'5" and weighs about 120, has been on Strattera for 3 weeks. Because she is also taking Prozac, the doctor has her on 30mg. of Strattera, which we give her 3 times a day. Once we got on that maintenance dose of 30, we saw lots of improvement, especially with inattention and improved mood. She's been on the maintenance dose about 2 weeks or so. In the last few days, it hasn't been working. She has had some congestion but her doc thinks it's allergy related. From our experience with Strattera in the past, it stops working when she's sick. HOWEVER, do you think it's possible that her body has adjusted to the maintenance dose and she needs an increase instead? Two years ago, when we were on Strattera, she weighed 79 lbs. and was on 60 mg. and tolerating it. We even went up to 72 mg. at one point but then came back down. Do you think she's on enough?

[Mayleng]

I would wait till her congestion clears up and then decide. Allergies and being sick does impact the effectiveness of some meds.

[nimsmum]

We started our son on Strattera in Nov/Dec last year, so he has been on it for about 3 months. We feel that it is making a difference, & amazingly no side effects at all. Teacher, tutor ourselves & my son all notice a difference in him being able to focus. We met with our pediatrician recently & he said he would keep him on the same dose although according to weight it could go up a bit. From what I've read here there is an exact dose related to weight, so I'm wondering if he is getting all the benefit he should be getting with the dose he is on now. Can anyone link me to medical information on this. I just want to be sure he is on the optimum dose. I guess I just don't want him doing a little bit better when he could be doing a lot better. He is on 40mg now, that's probably not a lot of help without knowing his weight is it. I'll have to check that later.

[Mayleng]

Here's some clinical studies.

Page down to Clinical Updates Special focus on atomoxetine, (atomoxetine is strattera).
www.manisses.com/2online/PUAlert/ARCHIVES/2002/PA12-05.html

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

[swmom]

We just recently increased dd's Strattera to 36mg. /daily from 30mg./daily. She's also on Prozac and Clonidine. We increased the Strattera a little bit to see if she could focus a little bit better. It has helped with that but we're also seeing the return of the some of the ocd behaviors(obsessive thinking) that the Prozac had addressed nicely. Could the increased Strat be reducing the effectiveness of the Prozac? We're also seeing the return of some irritability, which in dd, means anxiety. The increased Strattera may have increased her level of anxiety, too.

[Mayleng]

I don't know too much of the interaction of Strattera and prozac except they both use the same metabolic pathways, and strattera dose should be havled target dose because of that. Both meds are cousins, and strattera is supposed to help anxiety but on too much you would see mood problems and irritability is one of them. I would back it back down the strattera, and see if the irritability disappears.

[Mayleng]

More info on strattera:

www.johnswank.com/Strattera.htm

[sostressed]

I have some questions if you don't mind. I have waded though the 9 pages in this thread and don't see it.
I looked at the stopping meds for summer post but it was only stimulant related.
we have recently lost our neurodevelopmental ped and are now stuck with a gp. I feel like I know more than her about strattera.
Has anyone stopped strattera for the summer?
Our gp suggested it and I am very uncomfortable with it.
first off would you not have to gradually reduce the dose first?
and when changing dosages is that not when you have to be more on the look out for suicidal thoughts?

and by the time we reduced to the point he could stop taking it summer would be half over. would we be able to get back to the target dose by the time school started?
I feel like this doctor is not very informed about this med or how it works.
also he is on the maximum dose for his weight and is doing well on it but she keeps telling me that since he has been on it so long maybe we should increase the dose.

since the maximum dose even for adults is 100 and he is already on 80 should we not hold off on raising the dose until he either gains a lot of weight or shows signs of needing an increase?

[Mayleng]

You are right, it is not worth it to stop strattera for the summer. By the time you wean and ramp up, the summer is over and you run the risk of destabilizing his mood. Why do you want to stop the meds for the summer if he is doing well? Strattera is not a stimulant where you can start and stop immediately. Once you find the "right" dose, there is not need to keep increasing. I don't understand why the doctor would want to keep increasing the dose, seeing he is already on his maximum and DOING WELL on it. It just doesn't make any sense. I would keep him on the dose until you see that he needs an increase and I would still be cautious of going over the recommended dose for a child.

[sostressed]

Thank you.
To make matters worse she did not ask me privately if I wanted to stop for the summer. she asked in front of my son who right away piped up that yes he wanted to stop because his friend does not take their stimulant meds durring the summer.

I did not want to say to him in front of the doctor that she is an imbecile! But we argued all the way home and I had to explain to him all over again that what he takes is entirely different than what his friend takes and it is not something you stop just because it is saturday or because it is summer.

I am desperately searching for a new developmental ped but am having no luck and meanwhile we are stuck with this doctor.

[Mayleng]

Hopefully your son understands that there are different medications and each should be treated differently.

Keep looking for another doctor. It is important. If you cannot find a Development Ped try a Child Pyschiatrist, they treat adhd too and are more up-to-date on the various meds on this disorders than the GPs.

[cozysmom]

Two questions, please.

How much does Strattera help with impulsivity?

Is there any reason to believe that Strattera can effect the growth of the child?

Thanks!!! you guys!

Martha

[Mayleng]

Can't explain to you how much strattera helps with impulsivity - really depends on the individual - in some cases it helps in others it doesn't.

As for growth, this is what it said in their prescribing info on their site:

"Effects on Growth" - Data on the long-term effects of STRATTERA on growth come from open-label studies, and weight and height changes are compared to normative population data. In general, the weight and height gain of pediatric patients treated with STRATTERA lags behind that predicted by normative population data for about the first 9-12 months of treatment. Subsequently, weight gain rebounds and at about 3 years of treatment, patients treated with STRATTERA have gained 17.9 kg on average , 0.5kg more than predicted by their baseline data. After about 12 months, gain in height stabilizes, and at 3 years, patients treated with STRATTERA have gained 19.4 cm on average, 0.4 cm less than predicted by their baseline data."

[TerryB]

Mayleng,
Am I messed up or is my daughter's target dose a little high? She's 53 pounds so I get a target dose of about 29 mg. The doctor wants us to get to 40 mg.

[Mayleng]

Her minimum target dose is 28 mgs and maximum dose is 43mgs.

[TerryB]

That's good to hear from you. The package insert says that, "The total daily dose for children and adolescents should not exceed 1.4 mg per kg or 100 mg whichever is lower." This is under the section of Dosing of children and adolescents up to 70 kg body weight. That would give you a maximum of about 34.

Naturally the package insert is mostly about warnings such as suicide and little about the benefits of the medication so I'm not sure how seriously to take any of the information. I know that docs learn alot from clinical experience also, so the dosing might not be up to date.

Thanks,
Terry

[Mayleng]

Clinical studies went from 1.2mgs per kg to 2.2 mgs. The original insert says 1.2mgs to 1.8mgs per kg . I think they are now advising 1.4mg per kg because it is at the mid point. I do have to warn you that going up to 40mgs immediately is tough for some kids to take especially stomach problems and tiredness. So go up slowly. You could start at 10mgs for a few days, then increase to 20mgs for a few days and then go to 30mgs and see if that is enough, since 30mgs is still within the target dose. Keep it at 30mgs for 4 weeks and then see if that is enough. You won't see consistent results until being on target dose for 4 to 6 weeks. I think the doc wanted to go 40mgs because that is the next available dosage. If you use the 10,20 and 30mgs you will be using 10mgs pills. So your dd will have to take 3 pills of 10mgs to make up 30mgs. But it is much easier on them do the ramping up with lower increments of mags.

[TerryB]

He has started her on 18 x 1 week, 25 x 2 weeks and then 40 afterwards. We've done this for 2 days. The first night was fine. The second night she says she wasn't sleepy at bedtime, so couldn't go to sleep until late. She also woke up at 5 am and then went back to sleep. I can give her her full dose of her allergy med at night tonight and that should help. I had cut it back because it initially seemed too much.

Thanks Meyleng

[Mayleng]

Try giving her the pills after dinner instead of bedtime , and see if she can fall asleep earlier.

[TerryB]

I will do that! Thanks.

[nimsmum]

After a long wait I managed to see the doctor again about meds & I was pleased that he agreed to try our son on a higher dose. he is 115 pounds & is currently on 40mg, but has now been prescribed 60mg. From my calculations this is what I had worked out he should be on. He has not suffered any side effects. I forgot to ask about increasing slowly, is going from 40 to 60 in one jump OK? We are seeing some improvement, but I just felt that perhaps he is not on optimum dose & not getting full benefit.

Also he has released us to just follow up with our regular GP & said there are no ongoing testing needed, like blood tests etc. Is there anything that needs monitoring, I thought it strange that he doesn't need anything monitored except for weight.

Thanks so much for all replies.

[Mayleng]

If your son did not have any side effects while on strattera, then I guess jumping from 40mgs to 60mg might not be a problem for him. Some normally get tired or have stomach upset with a big jump.

Weight needs to be monitored, look out for suicidal thoughts and also the liver. My suggestion would be to ask your GP how familiar he is with strattera and if he is not, then go to strattera.com, and print out the prescribing information for Healthcare professionals and give him a copy.


pi.lilly.com/us/strattera-pi.pdf

[TerryB]

Anyone know if you can get refills of Strattera or if you have to have a new Rx written every month as with the stimulants? How many refills at a time generally?

[RobbysMom]

I had to get a new refill every 3 months and the nice thing is that your Dr can call it in so you don't have to go pick up the Rx at the Dr's office!!!

[swmom]

nimsmum -

Our dd, who weighs 114, is on the equivalent of 90mgs. of Strattera/daily and we're thinking about increasing it. I think your child may not be on nearly enough. The range for 114 pounds is 62.1 - 93.2. Our psychiatrist has told us that most kids do best at the higher end of their range.

[packmama3]

If my son weighs 83 pounds, what would be the max dosage that he could take? Psych wanted to try to raise his dose, but I didn't want to because of BP concerns. He has a ped appt today, it was 117/82 at the psych. (He is almost 8). He is on 40 mg currently, psych was considering 60 mg.

[Mayleng]

Maximum dose for 83 pounds using 1.8kg/mg is 68mgs.


The minimum dose is 45 mgs, so at 40mgs he is below is minimum dose.

To calculate the dosages you take the current weight

83lbs divided by 2.2 mulitply by 1.2 = minimum dose
83lbs divided by 2.2 multiply by 1.8 = maximum dose