# Strattera ### (atomoxetine)
**[Full Prescribing Information](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=309de576-c318-404a-bc15-660c2b1876fb&type=display)**[**DailyMed Drug Information**](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=309de576-c318-404a-bc15-660c2b1876fb)
--- **Forms/Strengths** - **Capsules:** 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg --- ### **Dosing** - **Age:** ≥ 6 - **Onset:** ~ 60 min - **Considerations:** Take the first dose on awakening. Additional doses may be given at intervals of 4-6 hours. - **Initial Dose:** - **≤70 kg:** 0.5 mg/kg/day (1 or 2 divided doses) - **>70 kg:** 40 mg daily - **Titration:** - **≤70 kg:** After at least 3 days at the initial dose, increase to approximately 1.2 mg/kg/day. - **>70 kg:** After at least 3 days at 40 mg/day, increase to 80 mg/day. If no improvement after 2-4 weeks, may increase up to 100 mg/day. - **Max Dose:** - **≤70 kg:** lesser of 1.4 mg/kg/day or 100 mg/day - **>70 kg:** 100 mg/day --- ### **Quick Facts** - Selective norepinephrine reuptake inhibitor; increases synaptic NE and indirectly boosts dopamine in the prefrontal cortex - Non-stimulant ADHD option; improves focus, attention, and impulse control - Oral capsule; weight-based, typically once-daily dosing - Common side effects: decreased appetite, nausea, dry mouth, fatigue, mood swings - Monitor for suicidal ideation in pediatric patients; consider liver function checks --- ### **Indications** - ADHD** (ICD-10: F90.0) --- ### **Off-Label Uses** - **Coexisting Anxiety or Tic Disorders**: Used off-label in patients with ADHD who may have anxiety or tic disorders, as an alternative to stimulants. - **Oppositional Defiant Disorder (ODD)**: May help reduce irritability and impulsiveness when comorbid with ADHD. - **Autism Spectrum Disorder (ASD)-associated ADHD symptoms**: Sometimes considered when stimulants are not tolerated. - **Substance Use Disorder in ADHD patients**: Considered when stimulant misuse is a concern. --- ### **How to Take** - Take **once or twice daily**, with the **first dose in the morning**; if a second dose is needed, take it in the late afternoon. - Can be taken **with or without food**; taking with food may help reduce nausea. - **Swallow the capsule whole**; do not crush, chew, or open. - If a **dose is missed**, take it as soon as possible unless it is close to the next dose—do not double up. - **Do not abruptly stop** taking; consult a healthcare provider before discontinuation. --- ### **Side Effects** - Common: Somnolence, gastrointestinal symptoms, decreased appetite. - Serious: Increased heart rate and blood pressure, suicidal thoughts (black box warning), rare cases of hepatitis --- ### **Monitoring / Labs** - **Cardiovascular**: Baseline and routine monitoring of heart rate and blood pressure. - **Growth in Pediatrics**: Regular monitoring of height and weight to detect growth suppression. - **Psychiatric Symptoms**: Observe for mood changes, anxiety, or psychosis. - **Abuse Potential**: Monitor for misuse or diversion. --- ### **Education** - **When to Call the Doctor:** - Severe **mood changes, aggression, or suicidal thoughts**. - Symptoms of **liver dysfunction** (yellowing of the skin/eyes, dark urine, persistent nausea). - Unusual bruising or bleeding. - Severe dizziness, fainting, or difficulty urinating. - Chest pain, rapid heartbeat, shortness of breath (**cardiovascular concerns**). - **Safety Tips:** - **Monitor blood pressure and heart rate**, as Strattera may cause increases. - Use caution in patients with **a history of depression, bipolar disorder, or suicidal thoughts**. - Avoid **alcohol**, as it may increase drowsiness and liver toxicity risk. - May cause **drowsiness**; use caution when driving or operating heavy machinery. - **Tapering may be needed** when discontinuing to prevent withdrawal effects. - **Parent Tips for Pediatric Patients:** - Monitor for **behavioral changes, increased agitation, or suicidal thoughts**, particularly in the first few weeks. - May cause **drowsiness or fatigue**—observe how the child responds to the medication. - Encourage **hydration and balanced meals** to minimize side effects. - If taken for **ADHD**, track progress with teachers and caregivers to assess effectiveness. --- ### **Additional Information** - **Contraindications:** - **Hypersensitivity** to atomoxetine or formulation components. - **Use within 14 days of MAOI therapy** (risk of hypertensive crisis). - **Severe cardiovascular disease**, including history of stroke or arrhythmia. - **Narrow-angle glaucoma**. - **Pregnancy:** - **Category C**; use only if benefits outweigh risks. - Limited human data; animal studies suggest potential fetal harm. - **Lactation:** - **Unknown if excreted in breast milk**; use with caution. - **Drug Interactions:** - **CYP2D6 inhibitors** (e.g., fluoxetine, paroxetine) may increase atomoxetine levels. - **Serotonergic drugs** (e.g., SSRIs, SNRIs, MAOIs) increase **serotonin syndrome risk**. - **Albuterol and other stimulants** may enhance cardiovascular side effects. - **Antihypertensive medications** may lead to excessive blood pressure lowering.