Strattera (Atomoxetine) Titration Schedule
The recommended titration schedule for Strattera (atomoxetine) is to start at a lower dose of 0.5 mg/kg/day for children and adolescents (or 40 mg daily for adults) and increase after a minimum of 3 days to a target dose of 1.2 mg/kg/day (or 80 mg daily for adults), with a maximum dose not exceeding 1.4 mg/kg/day or 100 mg daily. 1
Initial Dosing and Titration
For patients weighing less than 70 kg:
- Initial dose: 0.5 mg/kg/day
- Target dose: 1.2 mg/kg/day
- Maximum dose: 1.4 mg/kg/day or 100 mg/day (whichever is lower)
For patients weighing more than 70 kg:
- Initial dose: 40 mg daily
- Target dose: 80 mg daily
- Maximum dose: 100 mg daily
Titration Schedule
- Start with the initial dose for a minimum of 3 days
- If tolerated, increase to the target dose
- Allow at least 3 days between dose adjustments to assess tolerability
- Do not exceed the maximum recommended dose
Administration Options
Atomoxetine can be administered in one of two ways:
- As a single daily dose in the morning 2
- As two evenly divided doses in the morning and late afternoon/early evening 1
Single daily dosing has been shown to be as effective as divided dosing and may improve adherence 2.
Special Populations
Patients with Hepatic Impairment
- Moderate hepatic impairment: Reduce dose to 50% of the normal dose
- Severe hepatic impairment: Reduce dose to 25% of the normal dose 3
Poor CYP2D6 Metabolizers
Approximately 7% of the population are poor CYP2D6 metabolizers who may require lower doses due to slower clearance of atomoxetine 3, 4. These individuals typically have plasma concentrations approximately 10-fold higher than extensive metabolizers 4.
Monitoring During Titration
During the titration period, monitor for:
- Cardiovascular effects: Check blood pressure and heart rate at each visit 3
- Psychiatric effects: Monitor for increased anxiety, agitation, or suicidal ideation, particularly during the first few weeks 3
- Side effects: Common side effects include dry mouth, insomnia, nausea, decreased appetite, constipation, and dizziness 5
Efficacy Timeline
Patients may begin to experience symptom improvement as early as the first day of treatment, with continued improvement over the 8-week period 2. However, the full therapeutic effect may take several weeks to develop.
Important Considerations
- Atomoxetine is not a controlled substance and carries negligible risk of abuse or diversion 6, 5
- Unlike stimulants, atomoxetine can be safely used in patients with substance abuse concerns 7
- Atomoxetine provides continuous symptom relief that lasts throughout the day, including evening and morning hours when dosed appropriately 2
By following this structured titration approach, you can optimize the efficacy of Strattera while minimizing the risk of adverse effects.