What is the recommended dosing for Strattera (Atomoxetine) in adults?

Atomoxetine (Strattera) Dosing for Adults

For adults with ADHD, atomoxetine should be initiated at a total daily dose of 40 mg and increased after a minimum of 3 days to a target total daily dose of approximately 80 mg administered either as a single daily dose in the morning or as evenly divided doses in the morning and late afternoon/early evening. 1

Initial Dosing

• Start with 40 mg once daily for adults (over 70 kg) 1
• Continue this dose for a minimum of 3 days before considering dose adjustments 1
• Atomoxetine can be taken with or without food 1
• Capsules should be taken whole and not opened 1

Dose Titration

• After minimum 3 days at initial dose, increase to target dose of approximately 80 mg/day 1
• After 2-4 additional weeks, the dose may be increased to a maximum of 100 mg in patients who have not achieved optimal response 1
• No additional benefit has been demonstrated for doses higher than the recommended maximum 1, 2
• The maximum recommended total daily dose in adults is 100 mg 1

Administration Options

• 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, 2
• Once-daily dosing has been shown to be effective and may improve adherence 2, 3

Special Populations

• For patients with moderate hepatic impairment (Child-Pugh Class B), initial and target doses should be reduced to 50% of the normal dose 1
• For patients with severe hepatic impairment (Child-Pugh Class C), initial and target doses should be reduced to 25% of normal 1
• For patients taking strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine) or who are known CYP2D6 poor metabolizers, atomoxetine should be initiated at 40 mg/day and only increased to the usual target dose of 80 mg/day if symptoms fail to improve after 4 weeks and the initial dose is well tolerated 1, 4

Monitoring

• Monitor patients closely for suicidality, clinical worsening, and unusual changes in behavior, especially during the first few months of treatment or at times of dose changes 5
• Common adverse effects include dry mouth, insomnia, nausea, decreased appetite, constipation, dizziness, sweating, dysuria, sexual problems and palpitations 2, 3
• Modest increases in heart rate and blood pressure may occur but are generally well tolerated 2, 3

Clinical Considerations

• Atomoxetine is a non-stimulant medication with negligible risk of abuse or diversion 2, 3
• It is particularly useful for patients at risk for substance abuse or who do not wish to take a controlled substance 2, 3
• Atomoxetine can be discontinued without being tapered 1
• The safety of single doses over 120 mg and total daily doses above 150 mg have not been systematically evaluated 1

Efficacy

• Clinical trials have shown mean reductions in ADHD symptom scores of approximately 28-30% with atomoxetine versus 18-20% with placebo 2, 3
• Continued efficacy has been demonstrated in longer-term treatment 2

Remember to periodically reevaluate the long-term usefulness of atomoxetine for the individual patient 1.