What is the recommended dosage of Strattera (atomoxetine) for children, adolescents, and adults?

Strattera (Atomoxetine) Dosing

Strattera dosing differs based on body weight: children and adolescents under 70 kg start at 0.5 mg/kg/day and titrate to 1.2 mg/kg/day, while those over 70 kg and adults start at 40 mg/day and titrate to 80 mg/day. 1

Children and Adolescents Under 70 kg

Initial Dosing:

• Start at approximately 0.5 mg/kg/day total daily dose 1
• For children weighing less than 25 kg, single doses should not exceed 15 mg 2
• Wait a minimum of 3 days before increasing the dose 1

Target Dosing:

• Increase to 1.2 mg/kg/day as the target dose 1
• Can be given as a single morning dose OR divided into morning and late afternoon/early evening doses 1
• Maximum daily dose: 1.4 mg/kg or 100 mg, whichever is less 1
• No additional benefit demonstrated for doses higher than 1.2 mg/kg/day 1

Children and Adolescents Over 70 kg and Adults

Initial Dosing:

• Start at 40 mg/day total daily dose 1
• Wait a minimum of 3 days before increasing 1

Target Dosing:

• Increase to 80 mg/day as the target dose 1
• Can be given as a single morning dose OR divided into morning and late afternoon/early evening doses 1
• After 2-4 additional weeks at 80 mg/day, may increase to maximum of 100 mg/day if optimal response not achieved 1
• The typical titration pattern is to adjust every 7-14 days from 40 mg to 60 mg, then to 80 mg/day 2
• Maximum recommended dose: 100 mg/day 1

Special Populations Requiring Dose Adjustment

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 (paroxetine, fluoxetine, quinidine):

• Children/adolescents under 70 kg: Start at 0.5 mg/kg/day, increase to 1.2 mg/kg/day only if symptoms fail to improve after 4 weeks and initial dose is well tolerated 1
• Children/adolescents over 70 kg and adults: Start at 40 mg/day, increase to 80 mg/day only if symptoms fail to improve after 4 weeks and initial dose is well tolerated 1

Pre-Treatment Requirements

Baseline Assessment:

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

Administration Considerations

Practical Points:

• May be taken with or without food 1
• Capsules must be swallowed whole; do not open 1
• Can be discontinued without tapering 1
• Single morning dose has been shown effective into the evening 3

Common Pitfalls to Avoid

Dose Escalation:

• Avoid increasing the dose too rapidly, as this can cause initial somnolence and gastrointestinal symptoms 2
• Always wait the minimum 3 days between dose increases 1

Safety Monitoring:

• The safety of single doses over 120 mg and total daily doses above 150 mg have not been systematically evaluated 1
• Monitor for suicidal ideation, particularly early in treatment, as atomoxetine carries a black-box warning for this risk 3
• Rarely associated with serious liver injury; monitor for signs of hepatic dysfunction 3