Can I increase Atomoxetine (Strattera) from 40mg daily to 80mg daily after 5 days?

Atomoxetine Dose Increase from 40mg to 80mg After 5 Days

No, you should not increase atomoxetine from 40mg to 80mg after only 5 days of treatment. According to the FDA label, atomoxetine should be increased after a minimum of 3 days to the target dose, followed by an additional 2-4 weeks before considering further dose adjustments. 1

Proper Atomoxetine Titration Schedule

The FDA-approved dosing guidelines for atomoxetine in adults and children over 70kg are:

1. Initial dose: Start with 40mg daily
2. First increase: After a minimum of 3 days, increase to target dose of 80mg daily
3. Further adjustments: After 2-4 additional weeks, dose may be increased to maximum 100mg if optimal response not achieved 1

This titration schedule allows your body to adjust to the medication while minimizing side effects and optimizing efficacy.

Rationale for Following the Recommended Schedule

• Pharmacokinetics: Atomoxetine requires time to reach steady-state concentrations in the body
• Side effect management: Gradual titration reduces the risk and severity of adverse effects
• Efficacy assessment: Proper evaluation of response requires adequate time at each dose level

Safety Considerations

Increasing the dose too rapidly may lead to:

• Increased adverse effects: Common side effects include nausea, vomiting, fatigue, decreased appetite, abdominal pain, and somnolence 2
• Cardiovascular risks: Atomoxetine can cause increases in blood pressure and heart rate that could be clinically important (15-20 mmHg in blood pressure or 20 beats per minute in heart rate) 1
• Psychiatric effects: Risk of suicidal ideation, especially in children and adolescents, requiring careful monitoring during dose adjustments 1

Special Populations and Considerations

• CYP2D6 poor metabolizers: If you are taking medications that inhibit CYP2D6 (e.g., paroxetine, fluoxetine) or are a known poor metabolizer, dose increases should be even more conservative - only increasing if symptoms fail to improve after 4 weeks and the initial dose is well tolerated 1

• Hepatic impairment: Patients with moderate to severe hepatic impairment require significant dose reductions (50% and 75% respectively) 1

Optimal Dosing Strategy

For best results:

1. Take the 40mg dose for at least 3 days as prescribed
2. Increase to 80mg after at least 3 days (as directed by your prescriber)
3. Remain on 80mg for 2-4 weeks before considering any further dose adjustments
4. Monitor for side effects and therapeutic response throughout the titration process

Monitoring Recommendations

• Track improvements in ADHD symptoms
• Monitor blood pressure and heart rate
• Watch for mood changes, especially irritability or unusual behaviors
• Report any concerning side effects to your healthcare provider

Following this evidence-based approach will help maximize the benefits of atomoxetine while minimizing potential risks.