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Generic Strattera ( Atomoxetine )
Strattera (atomoxetine hydrochloride) is a selective norepinephrine reuptake inhibitor indicated for the treatment of attention deficit hyperactivity disorder (ADHD) in children (6 years and older), adolescents, and adults. It works by selectively inhibiting the presynaptic norepinephrine transporter, increasing noradrenergic and dopaminergic signalling in the prefrontal cortex, which improves attention, concentration, and impulse control. Unlike stimulant medications, Strattera is not a controlled substance and has a lower potential for abuse. It is not a psychostimulant and may be preferred in patients with a history of substance misuse or when stimulants are contraindicated. Strattera requires continuous daily dosing for full therapeutic effect and is not intended for as-needed use.
Usual adult dose: For adults and adolescents weighing more than 70 kg, the recommended starting dose is 40 mg once daily, taken orally in the morning or evening. After a minimum of 3 days at the starting dose, the dose may be increased to a target of 80 mg once daily, or 40 mg twice daily (morning and late afternoon), depending on tolerability and response. The maximum recommended daily dose is 100 mg. For patients weighing less than 70 kg, the starting dose is 0.5 mg/kg once daily, increased after at least 3 days to a target of 1.2 mg/kg daily, not to exceed 100 mg. The 10 mg, 18 mg, and 25 mg capsules are used for initial dose titration in children, adolescents, or adults who require lower starting doses or are sensitive to the medication. The 40 mg capsule is the standard adult starting and maintenance strength. Capsules must be swallowed whole with water; they should not be opened, crushed, or chewed. Strattera may be taken with or without food. If a dose is missed, it should be taken as soon as remembered, but if it is close to the next scheduled dose, the missed dose should be skipped; two doses should not be taken at the same time. No dose adjustment is required in renal impairment, but in patients with moderate or severe hepatic impairment, the dose should be reduced to 50% or 25% of the usual dose, respectively. Abrupt discontinuation is not associated with withdrawal symptoms, but the dose may be tapered if needed. Strattera is not recommended in patients with narrow-angle glaucoma, severe cardiovascular disorders, or pheochromocytoma.
Dosage form: Hard gelatin capsules: 10 mg (white/opaque white, size 4, imprinted with "LILLY 3227" and "10 mg"), 18 mg (gold/opaque white, size 4, imprinted with "LILLY 3238" and "18 mg"), 25 mg (blue/opaque white, size 3, imprinted with "LILLY 3228" and "25 mg"), and 40 mg (blue/opaque blue, size 2, imprinted with "LILLY 3229" and "40 mg"). Available in blister packs or bottles of 30 or 100 capsules.
Onset of action: Initial improvement in ADHD symptoms may be noticed within the first 1 to 2 weeks of continuous therapy, but the full therapeutic effect usually requires 4 to 6 weeks of daily dosing at an optimized dose. Unlike stimulants, Strattera does not produce immediate symptom relief and requires consistent long-term use.
Duration of action: The elimination half-life of atomoxetine is approximately 5 hours in extensive metabolizers and up to 24 hours in poor metabolizers of CYP2D6. Once-daily morning dosing provides symptom control throughout the day and into the evening in most patients; some individuals may require twice-daily dosing to maintain benefit throughout the afternoon. The clinical effect lasts as long as the medication is taken regularly; symptoms may return within days to weeks after discontinuation.
Alcohol recommendation: Alcohol should be avoided or strictly limited during treatment with Strattera. Alcohol may increase the risk of central nervous system depression, dizziness, and drowsiness. It can also potentiate the cardiovascular effects of atomoxetine, including tachycardia and hypertension. Binge drinking is particularly dangerous and may increase the risk of liver injury. Patients should be counselled to abstain from alcohol, especially during the initial dose titration period.
Most common side effects: In adults, the most frequently reported adverse effects are dry mouth, insomnia, nausea, decreased appetite, constipation, dizziness, erectile dysfunction, dysmenorrhea, and hot flushes. In children and adolescents, common effects include abdominal pain, vomiting, decreased appetite, fatigue, and somnolence. Insomnia and appetite suppression are usually mild and tend to improve with continued use; taking the dose in the morning may reduce insomnia. Atomoxetine is associated with an increased risk of suicidal ideation in children and adolescents; patients should be monitored for mood changes, agitation, or unusual behaviour, especially during the first few months of treatment or after dose changes. Rare but serious hepatotoxicity has been reported; patients should seek immediate medical attention for unexplained nausea, fatigue, jaundice, or right upper quadrant pain. Strattera can increase heart rate and blood pressure; blood pressure and pulse should be measured at baseline and periodically. It is contraindicated in patients with known hypersensitivity to atomoxetine, symptomatic cardiovascular disease, moderate to severe hypertension, severe hepatic impairment, and in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing an MAOI. Priapism has been reported rarely in adult males. Strattera is available only by prescription in Canada and must be initiated and monitored by a healthcare professional experienced in ADHD management.
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