Therapeutic Dosing of Strattera (Atomoxetine) for a 13-Year-Old Female
For a 13-year-old female, 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 dose not exceeding 1.4 mg/kg/day or 100 mg daily, whichever is less. 1, 2
Initial Dosing
- Start with 0.5 mg/kg/day for the first 3 days
- Can be administered either as a single daily dose in the morning or divided into two doses (morning and late afternoon/early evening)
- Capsules should be taken whole, not opened 2
- May be taken with or without food 2
Dose Titration
- After a minimum of 3 days, increase to the target dose of 1.2 mg/kg/day
- No additional benefit has been demonstrated for doses higher than 1.2 mg/kg/day 2
- Maximum dose should not exceed 1.4 mg/kg/day or 100 mg daily, whichever is less 1, 2
Weight-Based Dosing Considerations
- For a 13-year-old female weighing ≤70 kg: Use the weight-based dosing approach (0.5 mg/kg/day initially, target 1.2 mg/kg/day)
- For a 13-year-old female weighing >70 kg: Use adult dosing (40 mg/day initially, target 80 mg/day, maximum 100 mg/day) 1, 2
Monitoring and Follow-up
- Monitor for common side effects: headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 3
- Check blood pressure and heart rate regularly as atomoxetine can cause slight increases in both 3
- Monitor height and weight, as there may be an initial decrease that typically normalizes over time 3
- Screen for bipolar disorder prior to starting treatment 2
Special Considerations
- If the patient has hepatic impairment:
- Moderate impairment (Child-Pugh Class B): Reduce dose to 50% of normal dose
- Severe impairment: Reduce dose to 25% of normal dose 2
- Approximately 7% of the population are poor CYP2D6 metabolizers who may require lower doses due to slower clearance of atomoxetine 1
- Unlike stimulants, atomoxetine has negligible risk of abuse or misuse and is not a controlled substance 3, 4
Advantages for This Age Group
- Can be particularly useful for patients with comorbid anxiety or tics 4
- Effective into the evening with once-daily morning dosing 3
- Discontinuation is not associated with symptom rebound 3
Atomoxetine is a selective norepinephrine reuptake inhibitor that has demonstrated efficacy in treating ADHD in children and adolescents. While it may be less effective than some extended-release stimulants, it provides a valuable non-stimulant option with a different side effect profile and no abuse potential 3, 4.