Adult ADD

Since Strattera first came on the market a few years ago, I tried a number of patients on it. Only a few benefited from it, and only at a fairly high dose (120 mg per day). All the others had unacceptable side effects, most often of the gastrointestinal tract, or had headaches. Since that time I have encountered many patients who were treated by other physicians with Strattera, and had similar experiences. Of course, most patients that already had good results with it would probably not ordinarily have come to me for help.

I see only adults in my practice. Perhaps it works better with children. Or perhaps patients seen in a studies funded by the manufacturer are different in some ways from those seen in my or similar practices. I am told that if the dose is started quite low and only slowly increased, fewer patients have unacceptable side effects.

Still, there are certain kinds of patients that psychiatrists prefer starting treatment for ADD with atomoxetine, namely…

* Patients who are receiving anti-psychotic medication. (Stimulants are thought to be more likely to induce psychosis.)
* Patients who were previously treated successfully with atomoxetine (slam dunk)
* Patients over 26 years of age. (This is possibly because of concerns about blood pressure increases in older patients.)
* Patients paying in cash. (Strattera is less expensive and may be more attractive to those without insurance.)
* Patients who are on Medicaid. (Governmental bureaucracy often makes it cumbersome for physicians to prescribe stimulants. Also some clinics wont prescribe stimulants since they can be misused and sold on the black market.)
* Patients who are seeeing a primary care doctor rather than a psychiatrists or other specialists. (Primary care doctors generally have less knowledge and experience treating ADD and using stimulants than do specialists.)

My interpretation of these findings suggests that physicians who are experienced in treating ADD first prescribe stimulants unless there is a good reason not to or unless the patient had a previous good response to atomoxetine.

Sometimes, when Strattera helps but not as much as one would wish, it is helpful to add a low dose of stimulants.

There are some problems prescribing atomoxetime. There is an interaction between Strattera and both Prozac (fluoxetine) and Paxil (paroxetine) that may require adjusting the dose of your Strattera. Also a very small number of patients taking Strattera have developed severe liver problems. Patients taking Strattera should be aware of the early symptoms of liver damage such as jaundice, pain inside the lower right rib cage (where the liver is), flu-like symptoms, and dark urine. (For information from the manufacturer, go to Strattera.com.)

In some children and teens, Strattera increases the risk of suicidal thoughts. A combined analysis of 12 studies of Strattera showed that in children and teens, 4 out of every 1000 patients developed suicidal thoughts, although no suicides occurred. A similar analysis in adults treated with Strattera did not reveal an increased risk of suicidal thoughts. Caution patients to inform you if they have thoughts of suicide or sudden changes in mood or behavior, especially at the beginning of treatment or after a change in dose.

Ask about any family history of bipolar illness (manic-depressive illness) or suicidal thoughts or actions before starting Strattera. Have patients call you right away if they develops new psychological symptoms such as abnormal thoughts/behaviors and/or extreme elevated or irritable moods while taking Strattera.

In your initial evaluation, ask about any heart problems, heart defects, high blood pressure, or a family history of these problems. Check carefully for heart problems before starting Strattera. Have patients call you right away if they have any signs of heart problems such as chest pain, shortness of breath, or fainting while taking Strattera. Rarely, sudden death has been reported in patients who have heart problems or heart defects. There have also been rare reports of stroke and heart attack.

Erections that won’t go away (priapism) have occurred rarely during treatment with Strattera. If an erection that lasts more than 4 hours, have the patient seek medical help right away.

Strattera should not be taken if patients…

* Are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI
* Have an eye problem called glaucoma
* Are allergic to anything in Strattera

What are the possible side effects of Strattera?
The most common side effects in children and teenagers were upset stomach, decreased appetite, nausea or vomiting, dizziness, tiredness, mood swings and slowing of growth in children.

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. Other serious side effects include allergic reactions such as swelling or hives.