Strattera Is a Non-Stimulant Drug for ADHD

Why this medication provides an alternative to traditional ADHD drugs

Doctor writing prescription, cropped
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Most of the drugs available to treat attention deficit hyperactivity disorder (ADHD) such as Adderall or Ritalin are stimulants, which is why Strattera, a non-stimulant drug for the condition, stands out.

The FDA has approved Strattera (atomoxetine) to treat ADHD in adults and children over age six. 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.

They 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.

Why Strattera Stands Out

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.

Several research studies 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.

Sources:

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

Since it is not considered a controlled substance, Strattera will be available with a regular prescription. This will mean that doctors can call it into a pharmacy and can give refills, unlike stimulants and other controlled substances, which require a new prescription each month. And your Pediatrician will also likely have samples available for your child to try.

The first studies of Strattera demonstrated one of the downsides to this medication, since unlike many of the once a day, long acting stimulants, Strattera is was given twice a day.

Once a day dosing has also now been studied too though, and showed that 'once-daily administration of atomoxetine is an effective treatment for children and adolescents with ADHD.'2

And so far, none of the studies showed that Strattera works better or has less side effects than stimulants. Like the stimulants, side effects of Strattera included poor appetite, nausea, vomiting, tiredness and upset stomach. And many children lost weight in the first few months after starting Strattera. However, a few long term studies, in which children took Strattera for over a year, did show that these children did gain weight well and their height increased too. Since poor weight gain is often a problem in children taking stimulants, this finding is welcome news and Strattera may be a good alternative for these children.

Also, Strattera is metabolized through the cytochrome P450 2D6 (CYP 2D6) pathway of the liver, and so it is possible that there will be interactions with other medications, like Paxil (paroxetine), Prozac (fluoxetine) and quididine.

The manufacturer also advises caution when giving a child both IV albuterol (which is rarely done) and Strattera, so this medication may not be a good choice for children with ADHD who also have asthma. And as Strattera can increase a child's blood pressure and heart rate, it should be used with caution in children with high blood pressure, a fast heart rate (tachycardia) or cardiovascular or cerebrovascular disease.

Another downside is that Strattera is only available as a capsule, and unlike Adderall XR, which can usually be opened and sprinkled on food, it is advised that Strattera be taken whole.

So while having a new treatment for children with ADHD is welcome and exciting news, until further studies have been done to show that Strattera is safer or more effective than stimulants, you shouldn't necessarily rush to your Pediatrician for a medication change.

However, Strattera may be a very good choice for children who have problems gaining weight while taking a stimulant, have other side effects, or if their ADHD symptoms are poorly controlled.

Also see our guide, Should We Try Strattera?, for more information.

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

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