Weaning Off Strattera When Starting Adderall
Yes, you should gradually wean off Strattera (atomoxetine) when starting Adderall (amphetamine/dextroamphetamine) to minimize potential side effects and ensure optimal treatment efficacy. 1
Rationale for Gradual Transition
- Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor that works by blocking the reuptake of norepinephrine in the brain 2
- Adderall works through a different mechanism as both a direct adrenergic receptor agonist and by causing the release of dopamine and norepinephrine from presynaptic terminals 1
- Abrupt discontinuation of Strattera may lead to withdrawal symptoms, while simultaneous full doses could potentially increase the risk of side effects
Recommended Transition Protocol
Initial Phase:
- Start with a low dose of Adderall (2.5-5 mg daily or twice daily) while maintaining your current Strattera dose 1
- Monitor for any adverse effects for 3-5 days
Gradual Reduction Phase:
- Begin reducing Strattera by approximately 25% of the original dose every 5-7 days
- Simultaneously, titrate Adderall dose upward as needed (typically by 5 mg weekly) up to a maximum of 50 mg daily 1
Final Phase:
- Complete discontinuation of Strattera once Adderall reaches therapeutic effect
- Continue monitoring for symptom control and side effects
Monitoring During Transition
- Blood pressure and heart rate: Both medications can affect cardiovascular parameters 1
- Sleep patterns: Adderall may cause insomnia while Strattera may cause somnolence 3
- Appetite changes: Both medications can decrease appetite 2, 3
- Mood changes: Monitor for irritability, anxiety, or unusual changes in behavior
- ADHD symptom control: Ensure symptoms remain adequately controlled during transition
Important Considerations
- Pharmacokinetic differences: Strattera has a half-life of 5.2 hours in extensive metabolizers and 21.6 hours in poor metabolizers 4, while Adderall has a shorter duration of action
- Drug interactions: The American Academy of Child and Adolescent Psychiatry advises monitoring for serotonergic effects when combining these medications, although serotonin syndrome is rare 1
- CYP2D6 metabolism: Strattera is primarily metabolized by CYP2D6, which shows genetic polymorphism 4. This may affect how quickly you can safely discontinue it
Potential Challenges During Transition
- Temporary symptom breakthrough: You may experience fluctuations in ADHD symptom control during the transition period
- Overlapping side effects: Both medications can cause similar side effects (decreased appetite, nausea), which may be temporarily intensified during transition
- Rebound effects: Some patients may experience rebound symptoms when reducing Strattera
When to Seek Medical Attention
- Significant increases in blood pressure or heart rate
- Severe headaches or dizziness
- Signs of allergic reaction
- Unusual changes in mood or behavior
- Suicidal thoughts (black box warning for Strattera) 2
Remember that this transition should always be supervised by your healthcare provider, who can adjust the schedule based on your individual response to the medication changes.