Strattera and the ADD Patient
by John H. Samson, M.D., F.A.A.P.
November 8, 2004
A week never goes by that I am not asked about Strattera. Some queries are from patients on stimulant therapy. Some are new referrals for Attention Deficit Disorder management. My experience with this medication has been positive. These frequent queries have led me to evaluate my experience.
This medication was introduced for general usage in 2002. Prior research had shown it to be safe and effective in clinical use. It’s main advantage over Ritalin and Dexedrine preparations was the fact that it was not a stimulant. The annoying side effects of decreased appetite, delayed sleep and motor tics were therefore not seen in patients who received it during the original trials.
Since the incorporation of Strattera into my practice, the experience has been similar to the clinical trials predating its introduction. Originally the dose recommended by the manufacturer was too low. We quickly realized the dosage schedule had to be altered. Subsequently the manufacturer has altered their recommendations.
We now use a schedule of:
week 1 .5 mg/kg/day
week 2 1.0
week 3 1.5
week 4 2.0
If the dose used provided good control of the symptoms we obviously did not go to the next level. This effective dose was continued daily until the clinical picture indicated that an increase was needed.
It appeared that Strattera was effective in 50-to-60 percent of our patients who had primary ADD. In our experience patients that were not helped by this drug developed the most common side effect before any positive result was noted; namely, lethargy that had compromised their normal function. Patients that had significant decreased appetite or delayed sleep lost these side effects of ADD therapy when they changed to Strattera.
Overall, Strattera seems to be a promising treatment modality. However, in my practice I have not yet adopted it as my first line medication. Since the effect is not instantaneous it is useless in single dose pretreatment for Continuous Performance Testing evaluations. Our old medications of Ritalin and Dexedrine give an immediate response after a single dose. Strattera has been a life saver for patients who cannot tolerate stimulant therapy. It has worked well in both pediatric and adult patients. Strattera has been a significant addition to the therapeutic armamentarium for Attention Deficit Disorder.
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