What is the recommended next dose increase for Strattera (atomoxetine) after 25 mg for a patient weighing 96 kg?

Atomoxetine Dose Increase for a 96 kg Patient

For a patient weighing 96 kg (212 lbs), the recommended next dose increase for Strattera (atomoxetine) after 25 mg should be to 40 mg daily for 3 days, then increased to the target dose of 80 mg daily. 1

Dosing Guidelines for Adults and Children >70 kg

• Atomoxetine dosing for adults and children weighing over 70 kg (including your 96 kg patient) follows a specific protocol:

  • Initial dose: 40 mg daily 1
  • Minimum duration at initial dose: 3 days before increasing 1
  • Target dose: 80 mg daily (can be given as a single morning dose or divided into morning and late afternoon doses) 1
  • Maximum dose: After 2-4 additional weeks, may increase to 100 mg daily if optimal response not achieved 1

• The FDA label clearly states that the maximum recommended total daily dose for adults and children over 70 kg is 100 mg 1

Administration Considerations

• Atomoxetine can be taken with or without food 1
• The medication can be administered either as a single daily dose in the morning or divided into two doses (morning and late afternoon/early evening) 1
• Capsules should be taken whole and are not intended to be opened 1
• No tapering is required when discontinuing atomoxetine 1

Safety Considerations

• The safety of single doses over 120 mg and total daily doses above 150 mg has not been systematically evaluated 1

• Monitor for potential side effects, which commonly include:

  • Gastrointestinal effects (nausea, vomiting, abdominal pain) 2
  • Decreased appetite 2
  • Somnolence 2
  • Headache 2

• For patients with hepatic impairment, dose adjustments are required:

  • Moderate hepatic impairment: reduce to 50% of normal dose 1
  • Severe hepatic impairment: reduce to 25% of normal dose 1

• For patients who are CYP2D6 poor metabolizers or taking strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine):

  • Start at 40 mg daily 1
  • Only increase to 80 mg if symptoms don't improve after 4 weeks and initial dose is well tolerated 1

Clinical Pearls

• Atomoxetine has a different mechanism of action than stimulants, acting as a selective norepinephrine reuptake inhibitor 2
• Unlike stimulants, atomoxetine has negligible abuse potential and is not a controlled substance 3
• Atomoxetine is particularly useful for patients at risk of substance abuse or those with comorbid anxiety or tics 3
• The medication may take several weeks to reach full effectiveness, unlike the more immediate effects seen with stimulants 4