What is the recommended dosing for Atomoxetine (Strattera) in a 9-year-old child with Attention Deficit Hyperactivity Disorder (ADHD)?

Atomoxetine (Strattera) Dosing for a 9-Year-Old Child with ADHD

For a 9-year-old child with ADHD, atomoxetine (Strattera) should be initiated at a dose of 0.5 mg/kg/day, titrated after 3 days to 1.2 mg/kg/day as a target dose, with a maximum recommended dose of 1.8 mg/kg/day or 100 mg total daily dose (whichever is less). 1

Initial Dosing and Administration

• Start with 0.5 mg/kg/day for the first 3 days to assess tolerability 1
• Increase to target dose of approximately 1.2 mg/kg/day after initial period 1
• Can be administered as a single morning dose or divided into two evenly split doses (morning and late afternoon) 1, 2
• For a 9-year-old child, single daily dosing in the morning is often preferred for convenience and has been shown to be effective throughout the day, including evening and morning hours 2

Titration Schedule

• Begin with the lowest available dose (typically 10 mg or 18 mg depending on weight) 3
• Increase dose weekly in increments based on response and tolerability 3
• Target dose should be approximately 1.2 mg/kg/day 1
• Maximum dose should not exceed 1.8 mg/kg/day or 100 mg total daily (whichever is less) 1, 3

Monitoring and Assessment

• Assess response using standardized ADHD rating scales completed by parents and teachers 3
• Monitor for side effects weekly during initial titration phase 3
• Common side effects include decreased appetite, somnolence, fatigue, nausea, and irritability 2
• Measure weight, blood pressure, and heart rate at baseline and at each follow-up visit 3
• Schedule follow-up appointments at least monthly until symptoms have stabilized 3

Advantages of Atomoxetine for Children

• Non-stimulant medication with no abuse potential 3, 4
• Once-daily dosing option provides continuous symptom relief throughout the day 2
• Effective for both inattentive and hyperactive/impulsive symptom clusters 2
• Particularly useful for children with comorbid anxiety or tics 4
• Effects can be observed beginning with the first day of treatment, though full therapeutic effect may take several weeks 2

Important Considerations and Caveats

• Atomoxetine is FDA-approved for children 6 years and older 1
• Unlike stimulants, atomoxetine may take 1-3 weeks to reach full therapeutic effect 4
• Medication should only be prescribed if ADHD symptoms cause significant impairment despite behavioral interventions 3
• Some children may metabolize atomoxetine more slowly due to genetic variations (CYP2D6 poor metabolizers), potentially requiring lower doses 1
• If inadequate response or intolerable side effects occur after appropriate titration, consider alternative medications such as methylphenidate 3

Safety Monitoring

• Monitor closely for potential side effects, particularly during initial titration 3
• Watch for rare but serious adverse events including suicidal ideation, liver injury, and cardiovascular effects 1
• Regular assessment of growth parameters is recommended as decreased appetite may affect weight gain 2
• Consider drug holidays (e.g., weekends, school breaks) to assess continued need and minimize potential growth effects 3