Switching from Strattera to Concerta: Protocol and Considerations
When transitioning from Strattera (atomoxetine) to Concerta (methylphenidate), an immediate transition can be safely made without a washout period, using appropriate dose conversion and monitoring for side effects.
Pharmacological Differences
- Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor that works by inhibiting presynaptic norepinephrine transporters, while Concerta (methylphenidate) is a stimulant medication that blocks dopamine and norepinephrine reuptake 1
- Atomoxetine has a longer half-life and is less effective than extended-release methylphenidate formulations like Concerta for ADHD symptom control 1
- Concerta provides consistent medication levels throughout the day with once-daily dosing due to its osmotic-release oral system (OROS) technology 2
Transition Protocol
- An immediate transition from Strattera to Concerta can be made without a washout period, as these medications have different mechanisms of action 3
- Start Concerta on the morning after the last dose of Strattera 3
- Initial Concerta dosing should be based on clinical assessment rather than direct conversion from atomoxetine dose, typically starting with lower doses and titrating up 3
Dosing Guidelines
- Typical starting doses for Concerta range from 18mg to 36mg once daily, depending on previous medication response and body weight 4
- Take Concerta in the morning with or without food (food does not significantly affect methylphenidate absorption from Concerta, unlike some other stimulant formulations) 5
- Titrate Concerta dose as needed, with maximum daily doses typically not exceeding 54mg for children/adolescents or 72mg for adults 4
Managing Side Effects During Transition
- Monitor for common side effects of Concerta including decreased appetite, insomnia, headache, and increased heart rate/blood pressure 2
- Nausea occurs in up to 25% of patients starting methylphenidate-based medications; taking Concerta with food may help reduce this side effect 3
- If oral tics develop with Concerta, consider adjunctive therapy with alpha-agonists such as clonidine or guanfacine 6
Special Considerations
- Concerta provides longer symptom control into the evening hours compared to immediate-release methylphenidate formulations 2
- The once-daily dosing of Concerta may improve medication adherence compared to multiple daily dosing regimens 3
- Concerta has a lower potential for abuse compared to immediate-release stimulant formulations due to its specialized delivery system 3
Monitoring Recommendations
- Assess effectiveness of Concerta for ADHD symptom control throughout the day, particularly during morning and afternoon hours 7
- Monitor vital signs regularly, as methylphenidate can cause small increases in blood pressure and heart rate 4
- Evaluate sleep quality, appetite, and growth parameters during follow-up visits 2
Potential Advantages of Switching
- Concerta may provide more effective symptom control than atomoxetine, particularly for core ADHD symptoms 1
- Once-daily dosing of Concerta eliminates the need for multiple daily doses, potentially improving adherence 2
- Concerta's effects last throughout the school/work day and into the evening, providing consistent symptom control 2