From the Guidelines
Strattera (atomoxetine) and Adderall (mixed amphetamine salts) have distinct mechanisms of action in treating ADHD, with Strattera being a selective norepinephrine reuptake inhibitor and Adderall directly stimulating the release of dopamine and norepinephrine while preventing their reuptake. The primary difference in their mechanisms of action is that Strattera increases norepinephrine levels in the brain by blocking its reabsorption, particularly in the prefrontal cortex where executive functions are regulated, as noted in the study by 1. In contrast, Adderall's action is more complex, involving the inhibition of dopamine and norepinephrine transporters, as well as other mechanisms, as discussed in the study by 1. Some key points to consider when comparing these two medications include:
- Onset of action: Adderall has a faster onset of action compared to Strattera, with effects typically lasting 4-6 hours for immediate-release formulations or 8-12 hours for extended-release versions, as mentioned in the study by 1.
- Side effects: Adderall may cause more pronounced side effects like appetite suppression and sleep disturbances, while Strattera has a more gradual onset but may provide more consistent symptom control throughout the day without the peaks and valleys associated with stimulants, as noted in the study by 1.
- Dependence potential: Adderall is classified as a controlled substance with potential for dependence, while Strattera is not, as discussed in the study by 1.
- Cardiovascular effects: Both medications can have cardiovascular effects, but the nature and extent of these effects differ, with Adderall potentially causing increased heart rate and blood pressure, and Strattera having a more nuanced effect on these parameters, as mentioned in the study by 1. Overall, the choice between Strattera and Adderall should be based on individual patient needs and circumstances, taking into account factors such as the severity of symptoms, presence of comorbidities, and potential for side effects, as recommended in the study by 1.
From the Research
Mechanism of Action of Strattera (Atomoxetine) and Adderall (Amphetamine and Dextroamphetamine)
- Strattera (Atomoxetine) is a selective norepinephrine reuptake inhibitor, which means it works by increasing the levels of norepinephrine in the brain by blocking its reuptake 2, 3, 4.
- Adderall (Amphetamine and Dextroamphetamine) is a stimulant that acts by increasing the presynaptic release of dopamine and other biogenic amines in the brain, and also inhibits the reuptake of dopamine and norepinephrine 5.
Key Differences in Mechanism of Action
- The primary difference between Strattera and Adderall is that Strattera is a non-stimulant, selective norepinephrine reuptake inhibitor, whereas Adderall is a stimulant that affects multiple neurotransmitters, including dopamine and norepinephrine 2, 5.
- Strattera has a more targeted mechanism of action, primarily affecting norepinephrine levels, whereas Adderall has a broader mechanism of action, affecting multiple neurotransmitters and pathways 3, 5.
Clinical Implications of the Difference in Mechanism of Action
- The difference in mechanism of action between Strattera and Adderall may affect their efficacy and tolerability in different patients, with Strattera being a useful option for patients who are at risk of substance abuse or who do not wish to take a controlled substance 2, 6.
- Strattera may also be a better option for patients with co-morbid conditions, such as anxiety or tics, due to its more targeted mechanism of action and lower risk of adverse effects 3, 6.