What is the proper dosage and treatment plan for Strattera (atomoxetine) for Attention Deficit Hyperactivity Disorder (ADHD)?

Proper Dosage and Treatment Plan for Strattera (Atomoxetine) for ADHD

Strattera (atomoxetine) should be initiated at 0.5 mg/kg/day and increased after a minimum of 3 days to a target dose of 1.2 mg/kg/day, with a maximum daily dose of 1.4 mg/kg or 100 mg (whichever is less) for children and adolescents up to 70 kg, while adults and children over 70 kg should start at 40 mg/day and target 80 mg/day with a maximum of 100 mg/day. 1

Dosing Guidelines by Weight

For Children and Adolescents ≤70 kg:

• Initial dose: 0.5 mg/kg/day
• Target dose: 1.2 mg/kg/day (after minimum 3 days)
• Maximum dose: 1.4 mg/kg/day or 100 mg, whichever is less
• Administration: Can be given as a single morning dose or divided into morning and late afternoon doses

For Adults and Children >70 kg:

• Initial dose: 40 mg/day
• Target dose: 80 mg/day (after minimum 3 days)
• Maximum dose: 100 mg/day
• Administration: Can be given as a single morning dose or divided into morning and late afternoon doses

Administration Guidelines

• Strattera can be taken with or without food
• Capsules should be taken whole, not opened
• No tapering is required when discontinuing
• Safety of single doses over 120 mg and total daily doses above 150 mg has not been systematically evaluated 1

Treatment Duration and Monitoring

• Long-term treatment is often necessary for ADHD management
• Periodic reevaluation of the long-term usefulness of the medication is recommended
• Regular monitoring of:
  • Blood pressure and heart rate (atomoxetine can cause modest increases)
  • Height and weight in pediatric patients (initial loss may occur but typically normalizes over time)
  • Liver function (rare cases of serious liver injury have been reported)
  • Suicidal ideation (carries a black box warning for increased risk in children and adolescents) 1, 2

Special Populations and Dosing Adjustments

Hepatic Impairment:

• For moderate hepatic impairment (Child-Pugh Class B): Reduce initial and target doses to 50% of normal dose 1

CYP2D6 Poor Metabolizers:

• Dosage adjustment may be necessary as these patients have greater exposure to and slower elimination of atomoxetine 2

Patients with Bipolar Disorder Risk:

• Screen for personal or family history of bipolar disorder before initiating treatment 1
• Atomoxetine (starting dose 0.5 mg/kg/day, target dose 1.2 mg/kg/day) is recommended for patients with potential mood vulnerability 3

Clinical Advantages and Considerations

• Non-stimulant option with established efficacy
• Negligible risk of abuse or misuse (not a controlled substance)
• Particularly useful for:
  • Patients at risk for substance abuse
  • Patients with comorbid anxiety or tics
  • Patients who prefer not to take controlled substances 2, 4
• May be less effective than extended-release methylphenidate or mixed amphetamine salts, but comparable to immediate-release methylphenidate 2

Side Effect Profile

• Common side effects: headache, abdominal pain, decreased appetite, vomiting, somnolence, nausea, dry mouth, insomnia, constipation, dizziness, sweating
• Most adverse events are mild to moderate in severity
• Less likely than stimulants to cause insomnia or exacerbate sleep disorders
• More likely than stimulants to cause somnolence 2

Treatment Approach

• For optimal outcomes, combine atomoxetine with behavioral interventions:
  • Parent training in behavior management for children and adolescents
  • Cognitive Behavioral Therapy (CBT) for older adolescents and adults 3
• Regular follow-up within 2-4 weeks after medication initiation is recommended

By following these dosing guidelines and monitoring recommendations, atomoxetine can be an effective treatment option for ADHD in both pediatric and adult populations, with particular advantages for certain patient subgroups.