About Atomoxetine - ATX Strattera®

The Canadian ADHD Resource Alliance has a huge amount of resources on their website. I highly recommend you browse on by...

Here is a section in their Medications for ADHD about Strattera, the medication I will be put on this week (hopefully).

I have read about all sorts of less-than-positive experiences on Strattera, and had some very helpful e-mails and comments to urge me to research it. I'm going to see how it goes - but will definitely be my own advocate in the event that I am badly affected by side effects, or if it simply doesn't do anything for me. Thank you everyone for your interest and input - I really appreciate it!

"Atomoxetine - ATX
Strattera®

Atomoxetine is a specific noradrenaline (a.k.a. norepinephrine) reuptake inhibitor and comes in seven doses (10, 18, 25, 40, 60, 80 and 100 mg). ATX is not classified amongst the psychostimulants and it is not a controlled substance.

The major strengths of ATX are that: a) it provides continuous coverage including the late evening and early morning periods; b) it is indicated by Health Canada in all ADHD patients across the lifespan; c) it may be particularly useful for ADHD patients who have tic spectrum disorders or comorbid anxiety, resistance and/or side effects to stimulant medications, and there is little problems with worsening of sleep; d) at this time, there appears to be no substance abuse or diversion potential; e) samples may be available to establish efficacy before a commitment is made though it is covered by the majority of private insurance carriers; f) it may be covered by some provincial special access programs, and g) a new indication may be emerging for its use in enuresis.

The onset of action is slower than stimulants as they act on different neurotransmitters and the maximum treatment effect may not be reached for two months. The clinical changes are gradual. It would not be suitable in cases where there is an urgency to obtain a rapid onset of action. The dose is calibrated to the weight of the patient (see relevant tables for initiation, titration and maximum doses). There appears to be no increased benefit past 1.4 mg/kg/day though there may be some improvement of ODD after 1.8 mg/kg/day.

The American Academy of Child and Adolescent Psychiatry has stated that the doses could go as high as 2.2 mg/kg/day but this is much higher than the Canadian standard. If higher doses are contemplated, a referral to an ADHD specialist should be made. If the doses should exceed one pill a day, the cost of the medication is doubled. The capsules should never be opened as it may cause irritation of the gastric lining. The medication's safety profile has been established including the same risk factors related to cardiovascular conduction irregularity similar to those of stimulant drugs. Two cases of reversible alteration in hepatic enzyme are noted. No special monitoring protocol is required (i.e., blood tests) but patients should be advised of the clinical symptoms of hepatic dysfunction. Poor metabolizers (i.e., 7% Caucasians and 2% African-Americans) are unlikely to have toxic effects given the slow titration schedule.

Measurements of blood levels are not required. There have been rare reports of increase in suicidal ideation; one suicide attempt (overdose) was identified; no completed suicides occurred. Clinicians need to carefully monitor suicidal ideation, especially in the early phases of treatment not unlike many antidepressant medications. The clinical efficacy was the same as stimulants in patients who were treatment naive. ATX can be combined with stimulants to augment the effect in the case that the clinician feels the patient has not achieved an adequate response, but in these circumstances, a referral to an ADHD specialist maybe indicated."

Cheers,

Mungo

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