What is the starting dose of Strattera (atomoxetine) for adults and children?

Starting Dose of Strattera (Atomoxetine)

For adults and adolescents over 70 kg, start atomoxetine at 40 mg orally once daily; for children and adolescents up to 70 kg, start at approximately 0.5 mg/kg/day. 1

Dosing for Children and Adolescents (≤70 kg)

• Initial dose: 0.5 mg/kg/day, administered either as a single morning dose or divided into morning and late afternoon/early evening doses 1
• Titration schedule: Increase after a minimum of 3 days to a target dose of approximately 1.2 mg/kg/day 1
• Maximum dose: Do not exceed 1.4 mg/kg/day or 100 mg total daily dose, whichever is less 1
• Children weighing less than 25 kg generally should not receive single doses greater than 15 mg 2

Dosing for Adolescents (>70 kg) and Adults

• Initial dose: 40 mg once daily 1, 2
• Titration schedule: Increase after a minimum of 3 days to a target dose of 80 mg/day, administered either as a single morning dose or divided doses 1
• Further titration: After 2-4 additional weeks, may increase to maximum of 100 mg/day in patients without optimal response 1
• Typical titration pattern: Adjust every 7-14 days from 40 mg to 60 mg, then to 80 mg/day 2
• Maximum dose: 100 mg/day or 1.4 mg/kg/day, whichever is less 2, 1

Administration Guidelines

• Atomoxetine may be taken with or without food 1
• Capsules should be swallowed whole and not opened 1
• Can be discontinued without tapering 1
• May be administered once daily in the morning or split into two evenly divided doses (morning and late afternoon/early evening) 1

Special Population Dosing Adjustments

Hepatic Impairment

• Moderate hepatic insufficiency (Child-Pugh Class B): Reduce initial and target doses to 50% of normal dose 1
• Severe hepatic insufficiency (Child-Pugh Class C): Reduce initial and target doses to 25% of normal dose 1

CYP2D6 Poor Metabolizers or Concurrent Strong CYP2D6 Inhibitors

For children/adolescents ≤70 kg:

• Start at 0.5 mg/kg/day 1
• Only increase to usual target of 1.2 mg/kg/day if symptoms fail to improve after 4 weeks and initial dose is well tolerated 1

For adolescents >70 kg and adults:

• Start at 40 mg/day 1
• Only increase to usual target of 80 mg/day if symptoms fail to improve after 4 weeks and initial dose is well tolerated 1
• This applies when using strong CYP2D6 inhibitors such as paroxetine, fluoxetine, or quinidine 1

Important Pre-Treatment Considerations

• Screen for personal or family history of bipolar disorder, mania, or hypomania before initiating treatment 1
• Obtain baseline blood pressure, pulse, height, and weight in context of physical examination 2
• Document prior treatments including previous medications, dosages, duration, response, and side effects 2

Common Pitfalls to Avoid

• Do not exceed maximum doses: The safety of single doses over 120 mg and total daily doses above 150 mg have not been systematically evaluated 1
• Avoid rapid titration: Minimum 3-day intervals between dose increases are required to assess tolerability 1
• Do not open capsules: Atomoxetine must be swallowed whole 1
• Monitor for early adverse effects: Initial somnolence and gastrointestinal symptoms can occur, particularly if dose is increased too rapidly 3