Strattera (Atomoxetine) Dosing and Administration for ADHD
For patients with ADHD, Strattera (atomoxetine) should be initiated at 0.5 mg/kg/day for children and adolescents up to 70 kg or 40 mg daily for adults and children over 70 kg, with increases after a minimum of 3 days to a target dose of 1.2 mg/kg/day or 80 mg daily, respectively. 1
Recommended Dosing Schedule
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 daily (whichever is lower)
- Clinical studies show 1.2 mg/kg/day is as effective as 1.8 mg/kg/day 2
Adults and Children (>70 kg)
- Initial dose: 40 mg daily
- Target dose: 80 mg daily (after minimum 3 days)
- Maximum dose: 100 mg daily
Administration Options
- Can be administered as a single morning dose or divided into two doses (morning and late afternoon) 3
- Clinical studies have demonstrated efficacy with both once-daily and twice-daily dosing 3
- May be taken with or without food
Special Populations
Hepatic Impairment
- Moderate impairment: Reduce to 50% of normal dose
- Severe impairment: Reduce to 25% of normal dose 1
Poor CYP2D6 Metabolizers
- Approximately 7% of the population are poor CYP2D6 metabolizers
- These patients may require lower doses due to slower clearance of atomoxetine 1
- Monitor more closely for side effects
Efficacy Considerations
- Atomoxetine is effective for both inattentive and combined ADHD subtypes 3
- Unlike stimulants, atomoxetine has no abuse potential and is not a controlled substance 4
- Particularly useful for:
Monitoring and Side Effects
Common Side Effects
- Gastrointestinal: dyspepsia, nausea, vomiting, decreased appetite
- Cardiovascular: modest increases in heart rate and blood pressure
- Other: headache, somnolence, dizziness 5, 6
Monitoring Parameters
- Blood pressure and heart rate at baseline and regularly during treatment
- Height and weight in children (initial weight loss may occur but typically normalizes over time)
- Hepatic function tests periodically
- Mental health status, including monitoring for suicidal ideation (black box warning) 1, 5
Clinical Pearls
- Therapeutic effects may take 1-2 weeks to become apparent, unlike the immediate effects seen with stimulants
- Atomoxetine can provide 24-hour symptom control when dosed appropriately
- Discontinuation does not require tapering and is not associated with symptom rebound 5
- Atomoxetine should not be used in patients with narrow-angle glaucoma, as it has been associated with mydriasis 1
Atomoxetine has demonstrated efficacy in multiple randomized controlled trials, with significant improvements in ADHD symptoms compared to placebo as measured by standardized rating scales 3, 2. The 1.2 mg/kg/day dose appears to be the optimal target dose, with higher doses not providing additional benefit 2.