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What Should I Know About Strattera for ADHD?

Strattera came out around January of 2003, and is becoming more and more popular as a treatment for ADHD. Strattera is a norepinephrine reuptake inhibitor that came on the market in 2003. It is becoming more and more popular as a treatment for ADHD and is available nationally. Strattera is a type of ADHD treatment that works differently from the other ADHD medications available.

Strattera works by selectively blocking the reuptake of the neurotransmitter norepinephrine by certain nerve cells in the brain. This increases the availability of norepinephrine, which is thought to be essential in regulating impulse control, organization and attention.

In clinical trials, some patients discontinued their stimulant medications within one or two days of beginning Strattera. But our reports are that ADHD kids who had been treated successfully with stimulants do not seem to respond as well to the Strattera as those ADHD kids who had never been treated with stimulants. This is probably true, as we have seen this happen with children and teens being treated with ATTEND. We think this is because even small doses of stimulants can be so effective that they "spoil" both the kids and the parents, and they want to keep taking at least a tiny dose of stimulant along with either their ATTEND or Strattera. Learn more information on Ritalin, and ATTEND at the ADHD Information Library.

Please take Strattera exactly as directed by your doctor. Strattera offers flexible dosing, once or twice daily. Discuss a convenient schedule for taking Strattera with your doctor.

Do not take Strattera with any other medications, even over-the-counter medications! You must talk with your doctor first! Talk to the Pharmacist too! Our reports indicate that there may be serious problems taking anti-depressants with Strattera. In fact, our reports indicate that there can be serious problems taking even Benedryl with Strattera. But our reports indicate that small doses of stimulants may be OK with Strattera, and may even enhance treatment.

Strattera may be taken with or without food. If you miss a dose, take it as soon as possible, but do not take more than your total daily dose in any 24-hour period. If possible, take Strattera at the same time every day to keep on schedule. Strattera capsules should never be broken and sprinkled on food. They must be taken whole.

Our reports indicate that it takes 4 to 6 weeks for Strattera to work well (to reach therapeutic levels). We believe that Lilly will experience the same problems that VAXA has in getting people to stick with ATTEND, which also takes 4 to 6 weeks to work well. The problem is that parents usually only give an intervention 2 weeks to work, and move on to something else if they haven't already seen the results they expect.

Stimulants, when prescribed with the correct dose, work in about 20 minutes, so parents tend to go back to using them, even with their harsher side-effects. After all, the parents don't experience the unpleasant side-effects -- their kids do. But the parents do enjoy the benefits of the medication around the home.

Our reports also indicate that Strattera, like Attend, has fewer "ups and downs" than stimulants. There can be some stomach problems, but there is less of a "rebound" effect. By the way, for reducing the "rebound" effect of stimulants, try drinking a Mountain Dew at the 3 hour mark (for Ritalin). This seems to help a great deal to eliminate the "crashing" off a dose of Ritalin, and make a smooth landing.

In one of the Strattera studies the researchers reported that adverse events did occur in some patients, including rhinitis (33.3%), headache (20%), anorexia (16.7%), and dizziness (16.7%). No serious side effects were observed and no patients stopped medication or discontinued the study due to adverse events.

There have been reports of prostate problems in men with ADHD from various sources, so men should be careful.

In each of six clinical trials, Strattera was better than placebo in reducing the symptoms of ADHD in children, adolescents and adults. The positive effects of Strattera were seen for overall ADHD symptoms including hyperactive /impulsive symptoms and inattentive symptoms. But we are not convinced that this statement is very powerful. Even coffee is better than placebo. Would you take a medication that was not better than placebo? ATTEND, which is a nutritional product, makes statistically significant improvements on the computerized TOVA CPT test in 70% of subjects, and 80% improve on Parent Rating Scales; Ritalin makes statistically significant improvements on the computerized TOVA CPT test in 80% of subjects. Is Strattera better than these?

So far, parents love the fact that this is not a triplicate prescription. Doctors love this too. Ritalin is a hassle to prescribe, and a hassle to get from the pharmacy. However, the bottom line needs to be seen in the real world. Does Strattera work better than Attend? Does Strattera work better than stimulants? Will there be any long-term side-effects? How long will families pay $200 a month before they switch to another treatment option?

You can learn more about Strattera at the ADHD Information Library.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of Incorporated.


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