Strattera

Strattera treats symptoms of attention deficit hyperactivity disorder (ADHD). This medication can cause a loss of appetite and cause difficulty falling asleep or staying asleep.

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Pharmacist, Walker Winn, PharmD, overviews the uses and common side effects of Strattera.
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Strattera Overview

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Strattera is a prescription medication used to treat attention deficit hyperactivity disorder (ADHD) in children and adults. Strattera belongs to a group of drugs called selective norepinepherine reuptake inhibitors, which are thought to work by increasing levels of norepinepherine, a natural chemical in the brain.

This medication comes in capsule form and is taken by mouth either once a day in the morning or twice a day, with or without food.
 
Common side effects of Strattera include upset stomach, decreased appetite, nausea, and vomiting.

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Strattera Cautionary Labels

precautionsprecautionsprecautionsprecautionsprecautions

Uses of Strattera

Strattera is a prescription medication used to treat attention deficit hyperactivity disorder (ADHD) in children and adults. Strattera may increase attention and decrease impulsiveness and hyperactivity in patients with ADHD. 

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Manufacturer

Strattera Drug Class

Strattera is part of the drug class:

Side Effects of Strattera

Serious side effects have been reported. See "Drug Precautions" section.

Common side effects in children and teenagers include:

  • upset stomach
  • decreased appetite
  • nausea or vomiting
  • dizziness
  • tiredness
  • mood swings

Common side effects in adults include:

  • constipation
  • dry mouth
  • nausea
  • decreased appetite
  • dizziness
  • trouble sleeping
  • sexual side effects
  • menstrual cramps
  • problems passing urine


Other serious side effects include:

  • serious allergic reactions (call your doctor if you have trouble breathing, see swelling or hives, or experience other allergic reactions)
  • slowing of growth (height and weight) in children
  • problems passing urine including
  • trouble starting or keeping a urine stream
  • cannot fully empty the bladder


Other information for children, teenagers, and adults:

  • Erections that won't go away (priapism) have occurred rarely during treatment with Strattera. If you have an erection that lasts more than 4 hours, seek medical help right away. Because of the potential for lasting damage, including the potential inability to have erections, priapism should be evaluated by a doctor immediately.
  • Strattera may affect your ability to drive or operate heavy machinery. Be careful until you know how Strattera affects you.
  • Talk to your doctor if you have side effects that are bothersome or do not go away.

Strattera Interactions

Tell your doctor about all the medicines that you take including prescription and nonprescription medicines, vitamins, and herbal supplements. Strattera and some medicines may interact with each other and cause serious side effects. Your doctor will decide whether Strattera can be taken with other medicines.

Especially tell your doctor if you take:

  • asthma medicines
  • anti-depression medicines including MAOIs
  • blood pressure medicines
  • cold or allergy medicines that contain decongestants


Know the medicines that you take. Keep a list of your medicines with you to show your doctor and pharmacist. Do not start any new medicine while taking Strattera without talking to your doctor first.

Strattera Precautions

The following serious side effects have been reported with use of Strattera :

1. Suicidal thoughts and actions in children and teenagers (see Black Box Warning). Children and teenagers sometimes think about suicide, and many report trying to kill themselves. Results from Strattera clinical studies with over 2200 child or teenage ADHD patients suggest that some children and teenagers may have a higher chance of having suicidal thoughts or actions. Although no suicides occurred in these studies, 4 out of every 1000 patients developed suicidal thoughts. Tell your child or teenager's doctor if your child or teenager has (or there is a family history of):

  • bipolar illness (manic-depressive illness)
  • suicide thoughts or actions before starting Strattera 

The chance for suicidal thoughts and actions may be higher:

  • early during Strattera treatment
  • during dose adjustments

Prevent suicidal thoughts and action in your child or teenager by:

  • paying close attention to your child or teenager's moods, behaviors, thoughts, and feelings during Strattera treatment
  • keeping all follow-up visits with your child or teenager's doctor as scheduled

Watch for the following signs in your child or teenager during Strattera treatment:

  • anxiety
  • agitation
  • panic attacks
  • trouble sleeping
  • irritability
  • hostility
  • aggressiveness
  • impulsivity
  • restlessness
  • mania
  • depression
  • suicide thoughts

Call your child or teenager's doctor right away if they have any of the above signs, especially if they are new, sudden, or severe. Your child or teenager may need to be closely watched for suicidal thoughts and actions or need a change in medicine.

2. Severe liver damageStrattera can cause liver injury in some patients. Call your doctor right away if you have the following signs of liver problems:

  • itching
  • right upper belly pain
  • dark urine
  • yellow skin or eyes
  • unexplained flu-like symptoms

3. Heart-related problems.

  • sudden death in patients who have heart problems or heart defects
  • stroke and heart attack in adults
  • increased blood pressure and heart rate

Tell your doctor if you have any heart problems, heart defects, high blood pressure, or a family history of these problems. Your doctor should check you carefully for heart problems before starting Strattera.

Your doctor should check your blood pressure and heart rate regularly during treatment with Strattera.

Call your doctor right away if you have any signs of heart problems such as chest pain, shortness of breath, or fainting while taking Strattera.

4. New mental (psychiatric) problems in children and teenagers.

  • new psychotic symptoms (such as hearing voices, believing things that are not true, being suspicious) or new manic symptoms

Call your child or teenager's doctor right away about any new mental symptoms because adjusting or stopping Strattera treatment may need to be considered.

Do not take Strattera if you:

  • are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI. Some names of MAOI medicines are Nardil (phenelzine sulfate), Parnate (tranylcypromine sulfate) and Emsam (selegiline transdermal system)
  • have an eye problem called narrow angle glaucoma
  • are allergic to anything in Strattera 
  • have or have had a rare tumor called pheochromocytoma

Strattera Food Interactions

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Strattera there are no specific foods that you must exclude from your diet when receiving Strattera.

Inform MD

Tell your doctor if you:

  • are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI. Some names of MAOI medicines are Nardil (phenelzine sulfate), Parnate (tranylcypromine sulfate) and Emsam (selegiline transdermal system).
  • have an eye problem called narrow angle glaucoma
  • are allergic to anything in Strattera 
  • have or have had a rare tumor called pheochromocytoma


Before starting Strattera tell your doctor about all health conditions (or a family history of) including if you:

  • have or had suicide thoughts or actions
  • have heart problems, heart defects, irregular heart beat, high blood pressure, or low blood pressure
  • have mental problems, psychosis, mania, bipolar illness, or depression
  • have liver problems

Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding.

Tell your doctor about all the medicines that you take including prescription and nonprescription medicines, vitamins, and herbal supplements.

Strattera and Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant. It is not known if Strattera will harm your unborn baby. Strattera has not been studied in pregnant women. Strattera should be used during pregnancy only if clearly needed.

Strattera and Lactation

Tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if Strattera is excreted in human breast milk or if it will harm your nursing baby.

Strattera Usage

  • Take Strattera exactly as prescribed. Strattera comes in different dose strength capsules.Your doctor may adjust the dose until it is right for you.
  • Do not chew, crush, or open the capsules. Swallow Strattera capsules whole with water or other liquids. Tell your doctor if you cannot swallow Strattera whole. A different medicine may need to be prescribed.
  • Avoid touching a broken Strattera capsule. Wash hands and surfaces that touched an open Strattera capsule. If any of the powder gets in your eyes rinse them with water right away and call your doctor.
  • Strattera can be taken with or without food.
  • Strattera is usually taken once or twice a day. Take Strattera at the same time each day to help you remember. If you miss a dose of Strattera , take it as soon as you remember that day. If you miss a day of Strattera , do not double your dose the next day. Just skip the day you missed.
  • From time to time, your doctor may stop Strattera treatment for a while to check ADHD symptoms.
  • Your doctor may do regular checks of the blood, heart, and blood pressure while taking Strattera . Children should have their height and weight checked often while taking Strattera Strattera treatment may be stopped if a problem is found during these check-ups.

Strattera Dosage

Take Strattera exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. Your doctor will determine the best dose for you.

Acute Treatment: Dosing of children and adolescents up to 70 kg body weight — Strattera should be initiated at a total daily dose of approximately 0.5 mg/kg and increased after a minimum of 3 days to a target total daily dose of approximately 1.2 mg/kg administered either as a single daily dose in the morning or as evenly divided doses in the morning and late afternoon/early evening. No additional benefit has been demonstrated for doses higher than 1.2 mg/kg/day.

The total daily dose in children and adolescents should not exceed 1.4 mg/kg or 100 mg, whichever is less.

Dosing of children and adolescents over 70 kg body weight and adults — Strattera should be initiated at a total daily dose of 40 mg and increased after a minimum of 3 days to a target total daily dose of approximately 80 mg administered either as a single daily dose in the morning or as evenly divided doses in the morning and late afternoon/early evening. After 2 to 4 additional weeks, the dose may be increased to a maximum of 100 mg in patients who have not achieved an optimal response. There are no data that support increased effectiveness at higher doses.

The maximum recommended total daily dose in children and adolescents over 70 kg and adults is 100 mg.

Maintenance/Extended Treatment: It is generally agreed that pharmacological treatment of ADHD may be needed for extended periods. The benefit of maintaining pediatric patients (ages 6-15 years) with ADHD on Strattera after achieving a response in a dose range of 1.2 to 1.8 mg/kg/day was demonstrated in a controlled trial. Patients assigned to Strattera in the maintenance phase were generally continued on the same dose used to achieve a response in the open label phase. The physician who elects to use Strattera for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.

 

Strattera Overdose

If you take too much Strattera, call your local Poison Control Center or seek emergency medical attention right away.

Other Requirements

  • Store Strattera in a safe place at room temperature, 59 to 86°F (15 to 30°C).
  • Keep Strattera and all medicines out of the reach of children.

Strattera FDA Warning

WARNING: SUICIDAL IDEATION IN CHILDREN AND ADOLESCENTS

Strattera increased the risk of suicidal ideation in short-term studies in children or adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Anyone considering the use of Strattera in a child or adolescent must balance this risk with the clinical need. Co-morbidities occurring with ADHD may be associated with an increase in the risk of suicidal ideation and/or behavior. Patients who are started on therapy should be monitored closely for suicidality (suicidal thinking and behavior), clinical worsening, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Strattera is approved for ADHD in pediatric and adult patients. Strattera is not approved for major depressive disorder.

Pooled analyses of short-term (6 to 18 weeks) placebo-controlled trials of Strattera in children and adolescents (a total of 12 trials involving over 2200 patients, including 11 trials in ADHD and 1 trial in enuresis) have revealed a greater risk of suicidal ideation early during treatment in those receiving Strattera compared to placebo. The average risk of suicidal ideation in patients receiving Strattera was 0.4% (5/1357 patients), compared to none in placebo-treated patients (851 patients). No suicides occurred in these trials.