From the Guidelines
Atomoxetine dose titration should be done in increments of 10-25 mg, with a maximum recommended dosage of 1.4 mg/kg/day or 100 mg/day, whichever is lower, as stated in the most recent evidence 1. When titrating atomoxetine, it is essential to follow a sequential, weight-based approach.
- For adults and children over 70 kg, the initial dose is typically 40 mg daily, which can be increased to 80 mg daily after 7-14 days, and further increased to a maximum of 100 mg daily if needed 1.
- For children under 70 kg, treatment usually begins at 0.5 mg/kg daily for 7-14 days, then increases to a target of 1.2 mg/kg daily 1. It is crucial to make dose adjustments gradually to minimize side effects such as nausea, decreased appetite, dizziness, and fatigue.
- The full therapeutic effect of atomoxetine may take 2-4 weeks to develop, and dose increases should be guided by clinical response and tolerability 1.
- Careful monitoring of blood pressure and heart rate is necessary, particularly during dose adjustments, and patients with hepatic impairment require lower doses, typically 50% of the standard dose 1.
From the FDA Drug Label
Atomoxetine capsules 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 After 2 to 4 additional weeks, the dose may be increased to a maximum of 100 mg in patients who have not achieved an optimal response.
The increment amount for atomoxetine (Strattera) dose titration is 40 mg to 80 mg after a minimum of 3 days, and then up to 100 mg after 2 to 4 additional weeks if needed, as there is no specific increment amount provided in the label. 2
From the Research
Atomoxetine Dose Titration
- The increment amount for atomoxetine (Strattera) dose titration is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, study 7 mentions that atomoxetine was started at 10-20 mg/day and titrated weekly up to 90 mg over 11 weeks, depending on response and adverse effects.
- This suggests that the dose titration may involve weekly increments, but the exact amount of the increment is not specified.
- Study 6 discusses the importance of adequate dosing and mentions that the recommended target dose is 80 mg/day, but does not provide information on the increment amount for dose titration.
Dose Titration in Clinical Practice
- Study 6 highlights the issue of suboptimal dosing of atomoxetine in clinical practice, with an average adult dose of approximately 60 mg/day being utilized, despite the recommended target dose of 80 mg/day.
- The study emphasizes the importance of setting patient expectations and keeping the patient at the target dose for an adequate length of time (about 4-6 weeks) prior to judging efficacy.
- However, the study does not provide specific guidance on the increment amount for dose titration.