Strattera (Atomoxetine) Dosing and Administration for ADHD
The proper dosage of Strattera (atomoxetine) for ADHD is an initial dose of 0.5 mg/kg/day, titrated to a target dose of 1.2 mg/kg/day, with a maximum recommended dosage of 1.4 mg/kg/day or 100 mg daily, whichever is lower. 1, 2
Dosing Protocol by Age and Weight
Children and Adolescents up to 70 kg:
- Initial dose: 0.5 mg/kg/day
- Target dose: 1.2 mg/kg/day
- Maximum dose: 1.4 mg/kg/day 3
- Dose is usually adjusted every 7-14 days 2, 1
Children and Adolescents over 70 kg and Adults:
- Initial dose: 40 mg/day
- Target dose: 80 mg/day
- Maximum dose: 100 mg/day 3
Administration Guidelines
- Can be administered as a single daily dose in the morning or divided into two evenly divided doses (morning and late afternoon/early evening) 4, 5
- May be taken with or without food 3
- Capsules should be swallowed whole and not opened 3
- Real-world data shows that adults are often underdosed at approximately 60 mg/day rather than the recommended 80 mg/day target dose, which may lead to suboptimal outcomes 6
Special Populations
Hepatic Impairment:
- Dosage adjustment required for moderate to severe hepatic impairment 3
- For moderate hepatic impairment (Child-Pugh Class B): reduce to 50% of normal dose
- For severe hepatic impairment (Child-Pugh Class C): reduce to 25% of normal dose
CYP2D6 Poor Metabolizers:
- Patients who are known CYP2D6 poor metabolizers or taking strong CYP2D6 inhibitors should receive adjusted dosing 3
- Initial dose and target dose should be reduced to avoid higher plasma concentrations 3
Safety Monitoring
- Black box warning: Increased risk of suicidal ideation in children and adolescents, particularly during the first few months of treatment 3, 1
- Regular monitoring of:
- Blood pressure and heart rate (atomoxetine can cause modest increases) 4
- Height and weight in pediatric patients (initial loss in expected growth may occur but typically normalizes over time) 4
- Signs of liver injury (discontinue if jaundice or laboratory evidence of liver injury) 3
- Emergence of new psychotic or manic symptoms 3
Clinical Considerations
- Atomoxetine is a selective norepinephrine reuptake inhibitor, not classified as a stimulant 4
- Unlike stimulants, atomoxetine has negligible risk of abuse or misuse and is not a controlled substance 4, 5
- Particularly useful for patients:
- Full therapeutic effect may take 4-6 weeks to achieve, unlike the more immediate effects seen with stimulants 6
Common Side Effects
- Children: headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 4
- Adults: dry mouth, insomnia, nausea, decreased appetite, constipation, dizziness, sweating, sexual problems, and palpitations 5
Atomoxetine provides an effective non-stimulant option for ADHD treatment with the advantage of once-daily dosing and no abuse potential, though it requires adequate dosing and sufficient treatment duration to achieve optimal clinical outcomes.