ADHD treatment often includes prescription medications, such as Strattera. In this Forbes article, Mindpath Health’s Zishan Khan, MD, discusses the use, side effects, medication interactions, and how Strattera compares to other ADHD medications, like Adderall or Ritalin.
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children in the U.S. Nearly 6 million children between 3 and 17 years old received an ADHD diagnosis at some point in their lives, according to data gathered from 2016 to 2019 by the Centers for Disease Control. For at least one-third of children with ADHD, the condition lasts into adulthood, according to the CDC.
People with ADHD often struggle with sitting still, paying attention, and controlling impulsive behaviors, according to the National Institute of Mental Health. However, plenty of treatments are available, including behavioral therapy and medication. Strattera is a drug prescribed to treat ADHD.
What is Strattera?
Strattera is the brand name for a medication called atomoxetine. It works differently from stimulant medications like Adderall to treat ADHD, says Dr. Zishan Khan, MD, a Texas-based psychiatrist and regional medical director at Mindpath Health.
“While stimulants tend to increase dopamine and norepinephrine [a hormone that increases alertness] availability in the brain, Strattera focuses primarily on norepinephrine,” says Dr. Khan.
Atomoxetine is a selective norepinephrine reuptake inhibitor that’s thought to work by increasing norepinephrine, a natural substance in the brain that helps control behavior.
“Strattera is an SNRI (serotonin and norepinephrine reuptake inhibitor), which means it’s a serotonin—thought of as the happy chemical in the brain—and norepinephrine inhibitor,” says Sam Zand, a Las Vegas-area psychiatrist.
The precise mechanisms of how atomoxetine works aren’t completely understood, though it’s thought to help modulate dopamine by increasing levels of the hormone in specific areas of the brain that amplify the user’s ability to pay attention while inhibiting other symptoms of ADHD, such as restlessness or inattention.
Strattera is FDA-approved for children as young as 6, adolescents, and adults, says Dr. Khan. However, it might take several weeks for people taking Strattera to notice its effects.
What is Strattera used for?
Strattera is prescribed for increasing attention and the ability to focus while reducing hyperactivity and impulsivity. The goal of the medication is to control ADHD symptoms rather than cure them, and it’s often part of a treatment plan that might also include therapy.
“Stimulant medications can lead to a decrease in appetite, which can impact a growing child,” says Dr. Khan. “A decrease in appetite can also be concerning for a patient with symptoms of an eating disorder.”
In addition, stimulants can cause arrhythmia, or irregular heartbeat, and lead to heart palpitations, he says. Patients with structural heart defects, a history of uncontrolled seizures, and improperly managed glaucoma should avoid using stimulant medications or use them cautiously, adds Dr. Khan.
Unlike stimulants, which can be habit-forming, Strattera has a very low risk of misuse or abuse potential, making it a suitable option for patients with a history of misusing substances, says Dr. Zand.
Strattera is taken either once a day in the morning—or twice a day, in the morning and evening, with or without food. Doctors typically prescribe a low-dose prescription to start and may increase a person’s dosage after a few days or weeks, depending on the drug’s efficacy.
The dosage of Strattera a person is prescribed depends on the patient’s weight, says Dr. Khan. For children and adolescents under 154 pounds (70 kilograms), Strattera is usually started at a total daily dose of about 0.5 milligrams per kilogram and is gradually increased to a target daily dose of 1.2 milligrams per kilogram.
Studies don’t show any discernible benefit for prescribing Strattera in doses higher than 1.2 milligrams per day per kilogram. For patients weighing more than 154 pounds, a prescription of Strattera usually begins at a total daily dose of 40 milligrams and gradually increases to 80 milligrams per day, sometimes in divided doses, says Dr. Khan. The maximum dosage for anyone is 100 milligrams a day.
When prescribing Strattera, Dr. Khan bases the appropriate dosage on the drug’s efficacy and side effects. “Rigidly following standard dosing guidelines isn’t always the best course for treatment for everyone. An experienced provider can offer a better, more personalized treatment regimen.”
Common Strattera side effects
Some of Strattera’s side effects are related to its effect on the neurotransmitter norepinephrine, which is involved with the body’s physiological response to stress, or “fight or flight” response, says Dr. Zand.
Adverse reactions of Strattera may include nausea and fatigue, decreased appetite, and drowsiness, according to the U.S. Food and Drug Administration (FDA).
According to the drug’s manufacturer, Eli Lilly, common side effects of Strattera in children and teenagers include:
- Upset stomach
- Decreased appetite
- Nausea or vomiting
- Mood swings
Common side effects in adults include:
- Dry mouth
- Decreased appetite
- Sexual side effects
- Difficulty urinating or emptying the bladder
Strattera’s effect on the serotonin transporter may also cause a decrease in libido and an increase in sexual dysfunction, says Dr. Khan.
Strattera’s manufacturer advises parents to monitor children on Strattera and to call their health care providers if children exhibit the following symptoms:
- Panic attacks
- Trouble sleeping
- Suicidal thoughts
“Most of the complaints associated with taking the medication involve abdominal discomfort, including an upset stomach and occasionally some nausea that can disrupt appetite,” says Dr. Khan. To help with abdominal discomfort, Dr. Khan recommends taking the medication with a snack or a small amount of food.
People should disclose any use of current medications before taking Strattera, including:
- Monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar) and tranylcypromine (Parnate)—even if a person has discontinued use within the past two weeks.
- Albuterol syrup or tablets (Vospire)
- Bupropion (Aplenzin, Forvivo, Wellbutrin, or Contrave)
- Fluoxetine (Prozac, Symbyax)
- Medications for high blood pressure
- Other antidepressants such as paroxetine (Paxil)
Eli Lily warns children and teens may experience suicidal ideations while taking Strattera. The risk is highest early in treatment and when changing dosage, according to the company.
“Because this medication modulates serotonin receptors, there’s a need to watch out for suicidal ideation,” says Dr. Khan. However, Strattera shouldn’t be avoided for fear that it will lead to suicide, he adds
How to know if Strattera is right for me?
Like most psychotropic medications, Strattera won’t work for everyone, says Dr. Zand. In addition, he cautions against rushing to medicate children diagnosed with ADHD too quickly.
Adults who consistently experience ADHD symptoms like difficulty focusing on work or maintaining concentration may also want to ask their health care provider about Strattera.
Strattera is generally well-tolerated and useful for people with ADHD who want to avoid stimulants, such as people concerned about substance misuse, people with a history of seizures, or improperly managed glaucoma, says Dr. Khan.