Strattera - A New ADHD Medication

While a lot of 'new' medications for treating ADHD have been Mygra introduced recently, like Adderall XR, Concerta, Focalin, Ritalin LA, etc., they are still all stimulants.

The FDA has now approved Strattera (atomoxetine), a new non-stimulant drug to treat ADHD in adults and children over age 6. This is not the first non-stimulant medication for ADHD though. Antidepressants, including Wellbutrin (bupropion hydrochloride) and tricyclics, like Desipramine and Imipramine, have long been considered second line medications, and are sometimes used when two or more stimulants don't work, are contraindicated, or cause too many side effects. Antidepressants are usually not considered to be as effective as stimulants though. And these medicines aren't FDA approved to treat ADHD, so Strattera's claim of being 'the first non-controlled medication that's FDA-approved to treat ADHD' is technically true.

The introduction of Strattera (pronounced Stra-tair-a) is going to be welcome news for most parents. Although widely known to be safe and effective, stimulants like Adderall and Ritalin, have long had a bad reputation and many parents are anti-Ritalin and hesitant to put their kids on a stimulant. So if it isn't a stimulant, how does Strattera work? It is thought to be 'a potent inhibitor of the presynaptic norepinephrine transporter,'¹ which causes more norepinehrine to be available to increase attention and control hyperactivity and impulsivity. Like the stimulants, it is not yet known exactly how Strattera works though.

Although a new medicine, six research studies have already been done that show that Strattera is safe and effective.

One of these studies, Atomoxetine and methylphenidate treatment in children with ADHD: a prospective, randomized, open-label trial,¹ compared Strattera and Ritalin. These children with ADHD, 228 in all, received either Strattera or Ritalin for 10 weeks, and those who took Strattera were found to have 'symptom reduction' and 'tolerability' that were 'comparable to that observed with' Ritalin.

Strattera Suicide Warning

Although infrequent, the FDA has warned about an increased risk of suicidal thinking in children and adolescents being treated with Strattera. Specifically, like many other psychiatric medications, the FDA states that Strattera 'may increase thoughts of suicide or suicide attempts in children and teens,' and that parents should call their child's doctor if their child has:

• new or increased thoughts of suicide
• changes in mood or behavior including becoming irritable or anxious

This warning doesn't mean that your child can't be prescribed Strattera or that he should stop taking Strattera if it is doing a good job managing his ADHD symptoms and not causing side effects. Instead, the benefit of taking Strattera should be weighed against the possible risks of the drug. And children taking Strattera should be 'observed closely for clinical worsening, suicidal thinking or behaviors, or unusual changes in behavior,' especially in the first few months of starting treatment or when the dosage is changed.

References:

¹Atomoxetine and methylphenidate treatment in children with ADHD: a prospective, randomized, open-label trial. Kratochvil CJ - J Am Acad Child Adolesc Psychiatry - 01-Jul-2002; 41(7): 776-84

²Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study. Michelson D - Am J Psychiatry - 01-Nov-2002; 159(11): 1896-901

Important Safety Information for Strattera

What is the most important information I should know about Strattera?

In some children and teens, Strattera increases the risk of suicidal thoughts or actions. Results from Strattera clinical studies with over 2200 child or teenage ADHD patients suggest that some children and teenagers may have a higher chance of having Tadacip suicidal thoughts or actions. Although no suicides occurred in these studies, 4 out of every 1000 patients developed suicidal thoughts. Call the doctor right away if your child or teenager has thoughts of suicide or sudden changes in mood or behavior, especially at the beginning of treatment or after a change in dose. Strattera is not approved for major depressive disorder.

Who should not take Strattera?

Strattera should not be taken if you or your child/teenager:

• Are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI. You or your child/teenager should also not take an MAOI within 14 days of stopping Strattera. This is to avoid a life-threatening condition.
• Have an eye problem called narrow angle glaucoma
• Are allergic to anything in Strattera
• Have or have had a rare tumor called pheochromocytoma

What other important information should I know about Strattera?

Tell your doctor or your child/teenager’s doctor if you or your child/teenager has (or if there is a family history of) bipolar illness (manic-depressive illness) or suicidal thoughts or actions before starting Strattera. Call the doctor right away if you or your child/teenager develops new psychological symptoms such as abnormal thoughts/behaviors and/or extreme elevated or irritable moods while taking Strattera.

Strattera can cause liver injury in some patients. Call your doctor right away if you or your child/teenager has itching, right upper belly pain, dark urine, yellow skin or eyes, or unexplained flu-like symptoms.

Tell your doctor if you or your child/teenager has any heart problems, heart defects, high blood pressure, or a family history of these problems. Your doctor should check you or your child/teenager carefully for heart problems before starting Strattera. Call your doctor right away if you or your child/teenager has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking Strattera. Sudden death has been reported in patients who have heart problems or heart defects. There have also been reports of stroke, heart attack, increased blood pressure and heart rate.

Serious allergic reactions have occurred in patients taking Strattera. Call your doctor if you or your child/teenager has trouble breathing, swelling, hives, or experience other allergic reactions.

Patients taking Strattera have experienced problems passing urine, including trouble starting or keeping a urine stream, and not being able to fully empty the bladder.

Erections that won't go away (priapism) have occurred rarely during treatment with Strattera. If you or your child/teenager has an erection that lasts more than 4 hours, seek medical help right away.

Talk to your healthcare provider if your child experiences slowing of growth (height and weight). Children should have height and weight checked often while taking Strattera and your healthcare provider may stop Strattera treatment if a problem is found during these checkups.

Strattera may affect your ability or your child/teenager’s ability to drive or operate heavy machinery. Be careful until you know how Strattera affects you or your child/teenager.

Tell your doctor about all the medicines that you or your child/teenager takes including prescription and nonprescription medicines, vitamins, and herbal supplements. Strattera and some medicines may interact with each other and cause serious side effects. Your doctor will decide whether Strattera can be taken with other medicines.

What are the common possible side effects of Strattera?

The most common side effects in children and teenagers include upset stomach, decreased appetite, nausea or vomiting, dizziness, tiredness, and mood swings.

The most common side effects in adults include constipation, dry mouth, nausea, decreased appetite, dizziness, trouble sleeping, sexual side effects, menstrual cramps, and problems passing urine.