What is the appropriate dose of Strattera (atomoxetine) for a patient weighing 161 pounds?

Appropriate Dosage of Atomoxetine (Strattera) for a 161-pound Patient

For a patient weighing 161 pounds (approximately 73 kg), the appropriate dose of atomoxetine (Strattera) should be initiated at 40 mg once daily and increased after a minimum of 3 days to a target dose of 80 mg daily, either as a single morning dose or divided into morning and late afternoon doses. 1

Initial Dosing and Titration

• For adults and children over 70 kg (154 pounds), atomoxetine should be initiated at a total daily dose of 40 mg 1
• After a minimum of 3 days, the dose can be increased to the target dose of approximately 80 mg daily 1
• The medication 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
• After 2 to 4 additional weeks, if optimal response is not achieved, the dose may be increased to a maximum of 100 mg daily 1

Maximum Dosage

• The maximum recommended total daily dose for adults and adolescents over 70 kg is 100 mg 1
• No additional benefit has been demonstrated for doses higher than the recommended target dose 1
• The safety of single doses over 120 mg and total daily doses above 150 mg have not been systematically evaluated 1

Administration Guidelines

• Atomoxetine capsules may be taken with or without food 1
• The capsules should be taken whole and are not intended to be opened 1
• Atomoxetine can be discontinued without being tapered 1

Special Considerations

For Patients with Hepatic Impairment

• For patients with moderate hepatic insufficiency (Child-Pugh Class B), initial and target doses should be reduced to 50% of the normal dose 1
• For patients with severe hepatic insufficiency (Child-Pugh Class C), initial and target doses should be reduced to 25% of normal 1

For CYP2D6 Poor Metabolizers or Patients Taking CYP2D6 Inhibitors

• For patients over 70 kg who are taking strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine) or who are known CYP2D6 poor metabolizers, atomoxetine should be initiated at 40 mg daily 1
• Dose should only be increased to the usual target dose of 80 mg daily if symptoms fail to improve after 4 weeks and the initial dose is well tolerated 1

Monitoring and Safety

• Prior to initiating treatment, screen patients for personal or family history of bipolar disorder, mania, or hypomania 1
• 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 2
• Common adverse effects include nausea, vomiting, fatigue, decreased appetite, abdominal pain, and somnolence 2
• Atomoxetine may cause statistically, but not clinically, significant increases in both heart rate and blood pressure in patients with ADHD 3

Efficacy Considerations

• Atomoxetine is a selective norepinephrine reuptake inhibitor that is effective for ADHD treatment 3, 4
• It can be administered either as a single daily dose or split into two evenly divided doses 4
• Atomoxetine has a negligible risk of abuse or misuse and is not a controlled substance in the US 4
• It is particularly useful for patients at risk of substance abuse, as well as those who have co-morbid anxiety or tics 4