What is the starting dose of Strattera (atomoxetine) for adults?

Starting Dose of Atomoxetine (Strattera) for Adults

For adults, atomoxetine (Strattera) should be initiated at a total daily dose of 40 mg and increased after a minimum of 3 days to a target dose of approximately 80 mg daily. 1

Detailed Dosing Information

Initial Dosing

• Adults (and children over 70 kg): Start with 40 mg once daily 1
• This initial dose should be maintained for a minimum of 3 days before considering dose increases 1, 2
• May be administered as a single morning dose or divided into two evenly divided doses (morning and late afternoon/evening) 1

Dose Titration

• After the initial 3-day period, increase to the target dose of 80 mg daily 1
• After 2-4 additional weeks, the dose may be increased to a maximum of 100 mg in patients who have not achieved optimal response 1
• Maximum recommended daily dose is 100 mg 1

Special Populations

Hepatic Impairment

• Moderate hepatic impairment (Child-Pugh Class B): Reduce initial and target doses to 50% of normal dose 1
• Severe hepatic impairment (Child-Pugh Class C): Reduce initial and target doses to 25% of normal dose 1

CYP2D6 Poor Metabolizers or Patients Taking CYP2D6 Inhibitors

• Start at 40 mg daily 1
• Only increase to the target dose of 80 mg if symptoms fail to improve after 4 weeks and the initial dose is well tolerated 1
• Approximately 7% of the population are poor CYP2D6 metabolizers who may require lower doses due to slower clearance of atomoxetine 2

Administration Guidelines

• Atomoxetine can be taken with or without food 1
• Capsules should be taken whole and are not intended to be opened 1
• Can be administered as a single daily dose in the morning or divided into two doses (morning and late afternoon/evening) 1, 3, 4

Monitoring Recommendations

• Regular monitoring of blood pressure and heart rate is recommended as atomoxetine can cause modest increases in both 3, 4
• Screen for bipolar disorder prior to initiating treatment 1
• Monitor for common side effects including dry mouth, insomnia, nausea, decreased appetite, constipation, dizziness, and sexual problems 3, 4

Clinical Considerations

• Unlike stimulants, atomoxetine is not a controlled substance and has negligible risk of abuse or diversion 3, 4
• Particularly useful for patients at risk of substance abuse or those who do not wish to take a controlled substance 3, 4
• No data support increased effectiveness at higher doses beyond the recommended range 1
• The safety of single doses over 120 mg and total daily doses above 150 mg has not been systematically evaluated 1

Atomoxetine offers an effective non-stimulant option for adults with ADHD, with the convenience of once or twice daily dosing and without the controlled substance restrictions associated with stimulant medications.