What is the recommended dose increase for a patient currently taking Strattera (atomoxetine) 40mg twice a day (BID)?

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Strattera (Atomoxetine) Dose Escalation from 40mg BID

For a patient currently on atomoxetine 40mg twice daily (total 80mg/day), increase to 100mg total daily dose after 2-4 weeks if optimal response has not been achieved. 1

Current Dosing Status

Your patient is currently taking 80mg total daily dose (40mg BID), which is the standard target dose for adults and adolescents over 70kg. 1

Dose Escalation Protocol

After 2-4 additional weeks at 80mg/day, increase to a maximum of 100mg total daily dose if the patient has not achieved optimal response. 1 This can be administered as:

  • 50mg twice daily (morning and late afternoon/early evening), OR 1
  • 100mg once daily in the morning 1

The maximum recommended total daily dose is 100mg. 1 There are no data supporting increased effectiveness at higher doses. 1

Key Dosing Principles

  • Minimum interval between dose increases: Wait at least 2-4 weeks at the current dose before escalating to assess therapeutic response. 1
  • Do not increase doses more frequently than every 2 weeks. 1
  • The 100mg maximum applies to all patients over 70kg body weight, both adolescents and adults. 1

When to Consider Dose Increase

Increase the dose only if the patient meets ALL of the following conditions: 1

  • Has not achieved optimal symptom control at 80mg/day
  • Has tolerated the current dose well without significant adverse effects
  • Has been on 80mg/day for at least 2-4 weeks

Discontinue atomoxetine if there is no response or improvement of symptoms after 6 months of treatment. 1

Important Safety Considerations

  • Common adverse effects include dry mouth, insomnia, nausea, decreased appetite, constipation, dizziness, sweating, and sexual dysfunction. 2, 3
  • Monitor heart rate and blood pressure as atomoxetine causes modest increases in both parameters, though these are generally well tolerated. 4, 3
  • Atomoxetine can be discontinued without tapering. 1

Special Circumstances Requiring Dose Adjustment

If your patient is taking strong CYP2D6 inhibitors (paroxetine, fluoxetine, quinidine) or is a known CYP2D6 poor metabolizer, the standard dosing does not apply. In these cases, atomoxetine should have been initiated at 40mg/day total and only increased to 80mg/day if symptoms failed to improve after 4 weeks. 1 Further increases beyond 80mg/day are not recommended in this population. 1

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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