What is the appropriate dose of Strattera (atomoxetine) for a 15-year-old patient weighing 57.6kg?

Atomoxetine (Strattera) Dosing for a 15-Year-Old Weighing 57.6kg

For a 15-year-old patient weighing 57.6kg, the appropriate dose of atomoxetine (Strattera) is 75mg daily, administered either as a single morning dose or divided into two doses (morning and late afternoon). 1

Initial Dosing

• Since the patient weighs 57.6kg (which is over 40kg), the appropriate dosing follows the "over 40kg" category 1
• Initiate treatment at 40mg total daily dose 1
• After a minimum of 3 days, increase to the target dose of approximately 80mg daily 1
• The dose can be administered either as a single morning dose or divided into two doses (morning and late afternoon/early evening) 1

Maintenance Dosing

• After 2-4 additional weeks, the dose may be increased to a maximum of 100mg if optimal response is not achieved 1
• The maximum recommended total daily dose for adolescents over 40kg is 100mg 1
• Long-term efficacy has been demonstrated in the dose range of 1.2-1.8mg/kg/day for pediatric patients 1

Administration Considerations

• Atomoxetine can be taken with or without food 1
• Capsules should be taken whole and not opened 1
• The medication can be discontinued without tapering 1

Special Considerations

• If the patient is a poor CYP2D6 metabolizer or is taking strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine), start at 40mg/day and only increase to 80mg/day if symptoms don't improve after 4 weeks and the initial dose is well tolerated 1
• Prior to initiating treatment, screen for personal or family history of bipolar disorder, mania, or hypomania 1

Monitoring

• Periodically reevaluate the long-term usefulness of the medication 1
• Monitor for potential side effects including headache, abdominal pain, decreased appetite, nausea, and somnolence 2
• Watch for changes in heart rate and blood pressure, as atomoxetine is generally associated with statistically (but not clinically) significant increases in these parameters 2
• Monitor height and weight, as there may be an initial loss in expected growth that typically returns to normal with longer-term treatment 2

Advantages of Atomoxetine

• Can be administered as a single daily dose or split into two doses 2
• Has negligible risk of abuse or misuse 2
• Not classified as a controlled substance 2
• Particularly useful for patients at risk of substance abuse or those with comorbid anxiety or tics 2, 3