Strattera (atomoxetine)
When Strattera first came on the market a few years ago, I tried a number of patients on it. Only one 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 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.)
