From the Guidelines
Atomoxetine (Strattera) should be initiated at a dose of 40 mg po daily, with titration every 7-14 days to a maximum dose of 1.4 mg/kg/d or 100 mg/d, whichever is lower, for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults and children. The medication is taken once daily, and full therapeutic effects may take 2-4 weeks to develop. Common side effects include decreased appetite, nausea, dry mouth, dizziness, and fatigue, as reported in studies such as 1. Unlike stimulants, atomoxetine is not a controlled substance and works by inhibiting norepinephrine reuptake, improving attention and impulse control, as explained in 1. It's particularly useful for patients with comorbid anxiety, tics, or substance use concerns, or those who experienced adverse effects with stimulants. Some key points to consider when prescribing atomoxetine include:
- Monitoring for rare but serious side effects, including liver problems, suicidal thoughts (especially in young patients), and cardiovascular effects, as warned in 1
- Checking blood pressure and heart rate regularly, as atomoxetine can have cardiovascular effects
- Taking the medication consistently for optimal effect, as the therapeutic effects may take some time to develop
- Being aware of the potential for increased adverse effects in poor metabolizers of atomoxetine, which may affect up to 7% of the population, as noted in 1. Overall, atomoxetine is a useful treatment option for ADHD, with a distinct mechanism of action and a relatively favorable side effect profile, as supported by studies such as 1 and 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Initial, Target and Maximum Daily Dose (2. 1) (Acute and Maintenance/Extended Treatment) Body Weight Initial Daily Dose Target Total Daily Dose Maximum Total Daily Dose Children and adolescents up to 70 kg 0.5 mg/kg 1.2 mg/kg 1.4 mg/kg Children and adolescents over 70 kg and adults 40 mg 80 mg 100 mg
The recommended treatment and dosage of Atomoxetine (Strattera) for Attention Deficit Hyperactivity Disorder (ADHD) is as follows:
- For children and adolescents up to 70 kg, the initial daily dose is 0.5 mg/kg, with a target total daily dose of 1.2 mg/kg and a maximum total daily dose of 1.4 mg/kg.
- For children and adolescents over 70 kg and adults, the initial daily dose is 40 mg, with a target total daily dose of 80 mg and a maximum total daily dose of 100 mg 2.
From the Research
Overview of Atomoxetine Treatment for ADHD
- Atomoxetine, also known as Strattera, is a selective norepinephrine reuptake inhibitor used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents, and adults 3, 4.
- It is not classified as a stimulant and has a negligible risk of abuse or misuse, making it a useful option for patients at risk of substance abuse or those who do not wish to take a controlled substance 3, 4.
Recommended Dosage
- The recommended dosage of atomoxetine for children and adolescents is 1.2-1.8 mg/kg/day, which can be administered as a single daily dose or split into two evenly divided doses 3, 5.
- For adults, the recommended dosage is 60-120 mg/day, which can be administered once or twice daily 4.
- The dosage may need to be adjusted based on the patient's response to treatment and tolerability 3, 4.
Efficacy and Safety
- Atomoxetine has been shown to be effective in reducing ADHD symptoms in children, adolescents, and adults, with significant improvements in attention and behavior 3, 4, 5.
- Common adverse events associated with atomoxetine include headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 3, 4, 5.
- Atomoxetine has a black-box warning for suicidal ideation, and rare cases of serious liver injury have been reported 3, 4.
Special Populations
- Atomoxetine has been studied in children as young as 3-6 years old with ADHD and autism spectrum disorder, and has been shown to be effective and well-tolerated in this population 6.
- However, close patient monitoring is essential, and long-term prospective studies are needed to fully assess the safety and efficacy of atomoxetine in this population 6.