Strattera (Atomoxetine) Starting Dose for Adults and Children
The starting dose of Strattera (atomoxetine) should be 40 mg once daily for adults and children over 70 kg, and approximately 0.5 mg/kg/day for children and adolescents up to 70 kg. 1, 2
Dosing Guidelines by Age and Weight
Children and Adolescents up to 70 kg
- Initial dose: 0.5 mg/kg/day 2
- Can be administered as a single daily dose in the morning or divided into two doses (morning and late afternoon) 2
- After a minimum of 3 days, increase to target dose of approximately 1.2 mg/kg/day 2
- Maximum daily dose: 1.4 mg/kg or 100 mg, whichever is less 1, 2
Adults and Children over 70 kg
- Initial dose: 40 mg once daily 1, 2
- After a minimum of 3 days, increase to target dose of approximately 80 mg/day 2
- Can be administered as a single daily dose in the morning or divided into two doses (morning and late afternoon) 2
- After 2-4 additional weeks, dose may be increased to a maximum of 100 mg in patients who have not achieved optimal response 2
- Maximum daily dose: 100 mg 1, 2
Special Dosing Considerations
Hepatic Impairment
- For moderate hepatic impairment (Child-Pugh Class B): Initial and target doses should be reduced to 50% of the normal dose 2
- For severe hepatic impairment (Child-Pugh Class C): Initial and target doses should be reduced to 25% of normal 2
CYP2D6 Poor Metabolizers or Patients Taking CYP2D6 Inhibitors
- For children and adolescents up to 70 kg: Start at 0.5 mg/kg/day and only increase to target dose of 1.2 mg/kg/day if symptoms don't improve after 4 weeks 2
- For adults and children over 70 kg: Start at 40 mg/day and only increase to target dose of 80 mg/day if symptoms don't improve after 4 weeks 2
Administration Guidelines
- Atomoxetine can be taken with or without food 2
- Capsules should be taken whole and not opened 2
- No tapering is required when discontinuing 2
Safety Monitoring
- Monitor patients closely for suicidality, clinical worsening, and unusual behavior changes, especially during the first few months of treatment or at times of dose changes 1
- Common adverse effects include nausea, vomiting, fatigue, decreased appetite, abdominal pain, and somnolence 1, 3
- Regularly assess vital signs as atomoxetine can cause modest increases in heart rate and blood pressure 4, 5
Clinical Advantages
- Atomoxetine is a non-stimulant medication with negligible risk of abuse or misuse 4, 6
- It can be particularly useful for patients at risk of substance abuse or those with comorbid anxiety or tics 6, 7
- Efficacy has been demonstrated in both short-term and long-term treatment of ADHD 3, 4
Atomoxetine's efficacy and safety profile make it a valuable option for ADHD treatment, with dosing that should be carefully titrated based on patient weight and response.