Do you need to wean off Strattera (atomoxetine) when adding Adderall (amphetamine and dextroamphetamine) to a treatment regimen?

Transitioning from Strattera to Adderall: No Need to Wean

When adding Adderall (amphetamine and dextroamphetamine) to a treatment regimen that includes Strattera (atomoxetine), you do not need to wean off Strattera first. 1 These medications have different mechanisms of action and can be safely used together when properly monitored.

Mechanism of Action Differences

• Strattera (Atomoxetine): Selectively inhibits presynaptic norepinephrine reuptake 2
• Adderall (Amphetamine/Dextroamphetamine): Acts as both direct adrenergic receptor agonist and causes release of dopamine and norepinephrine from presynaptic terminals 3

Safety of Combination Therapy

The different mechanisms of action allow for concurrent use without a tapering period. The American Academy of Child and Adolescent Psychiatry supports considering adjunctive therapy when stimulant therapy alone is not fully effective or limited by side effects 1.

Monitoring Recommendations

When adding Adderall to Strattera therapy, monitor for:

• Cardiovascular effects: Both medications can affect blood pressure and heart rate
• Sleep disturbances: Adderall may cause insomnia while Strattera is less likely to affect sleep 2
• Appetite changes: Both medications can reduce appetite
• Drug interactions: While direct interactions between these medications are minimal, both affect noradrenergic systems

Important Precautions

1. Avoid MAOIs: Combining either medication with monoamine oxidase inhibitors is contraindicated due to risk of serotonin syndrome 3
2. Start low: Begin Adderall at a low dose (2.5-5mg daily or twice daily) when adding to Strattera 3
3. Monitor vital signs: Regular assessment of blood pressure and heart rate is essential 1
4. Watch for serotonergic effects: Though rare with this combination, be alert for signs of serotonin syndrome (mental status changes, neuromuscular abnormalities, autonomic instability) 3

Dosing Considerations

• Strattera: Typical maintenance dose is 1.2 mg/kg/day (maximum 1.4 mg/kg/day or 100 mg, whichever is less) 1
• Adderall: Starting dose of 2.5-5 mg daily or twice daily, with dose range of 5-30 mg/day 3

Special Populations

For patients with substance use concerns, atomoxetine (Strattera) has negligible abuse potential compared to stimulants like Adderall 4, 5. This may influence the decision to maintain Strattera while adding Adderall.

Conclusion

The addition of Adderall to Strattera therapy does not require weaning off Strattera first. The medications work through different mechanisms and can be used concurrently with appropriate monitoring for side effects and drug interactions.