Starting Dose of Atomoxetine (Strattera) for an 11-Year-Old Child
For an 11-year-old child, atomoxetine (Strattera) should be initiated at a total daily dose of approximately 0.5 mg/kg/day and increased after a minimum of 3 days to a target total daily dose of approximately 1.2 mg/kg/day. 1
Initial Dosing Guidelines
- Atomoxetine should be started at 0.5 mg/kg/day for children weighing up to 70 kg 1
- The medication can be administered either as a single daily dose in the morning or as evenly divided doses in the morning and late afternoon/early evening 1
- After a minimum of 3 days at the starting dose, the dose can be increased to the target dose of approximately 1.2 mg/kg/day 1, 2
- No additional benefit has been demonstrated for doses higher than 1.2 mg/kg/day 1
Maximum Dosing Considerations
- The total daily dose in children should not exceed 1.4 mg/kg or 100 mg, whichever is less 1
- For children who are poor CYP2D6 metabolizers or taking strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine), atomoxetine should be initiated at 0.5 mg/kg/day and only increased to the usual target dose if symptoms fail to improve after 4 weeks and the initial dose is well tolerated 1
Administration Recommendations
- Atomoxetine can be taken with or without food, although taking it with food may improve gastrointestinal tolerability 1
- The capsules should be taken whole and are not intended to be opened 1
- The medication can be discontinued without being tapered 1
Efficacy Considerations
- Clinical trials have demonstrated that atomoxetine at 1.2 mg/kg/day is effective for treating ADHD symptoms in children 3
- A graded dose-response has been observed, with 1.2 mg/kg/day showing similar efficacy to 1.8 mg/kg/day, suggesting that 1.2 mg/kg/day is an appropriate initial target dose for most patients 3
Safety Monitoring
- Patients should be monitored closely for suicidality, clinical worsening, and unusual changes in behavior, especially during the first few months of treatment or at times of dose changes 2
- Common adverse effects include nausea, vomiting, fatigue, decreased appetite, abdominal pain, and somnolence 2, 4
- Prior to initiating treatment, patients should be screened for a personal or family history of bipolar disorder, mania, or hypomania 1
Clinical Pearls
- Atomoxetine is particularly useful for patients at risk of substance abuse, as well as those who have co-morbid anxiety or tics 4, 5
- Unlike stimulant medications, atomoxetine has a negligible risk of abuse or misuse and is not a controlled substance in the US 4, 5
- The full therapeutic effect may not be evident until 2-4 weeks of treatment at the target dose 4
- The duration of action extends throughout the waking hours, and the drug effects may persist up to the next morning with a single morning dose 6