Strattera Update

Strattera was approved by the FDA last year, and you have likely heard something about this new medicine by now, especially if you have a child with ADHD.

Most parenting magazines are now running ads for Stattera, with their 'welcome to ordianary' campaign. If you have a child that is very hyperactive or has a short attention span, an 'ordinary' day would seem welcome.

I have to admit that I was originally very skeptical about Strattera. The claims about what the medication could do seemed almost too good to be true. And I am usually not very interested in jumping on the bandwagon of a new drug or treatment, unless I am sure that it will benefit my patients.

I had originally decided to just try Strattera on kids who weren't doing well on a stimulant and I soon had an opportunity to prescribe Strattera.

My first prescription went to a child who I had newly diagnosed with ADHD, Combined Type and who did not do well at all with stimulants. I first tried Adderall XR and then Concerta, and with each, she did not tolerate the side effects, including irritability and trouble sleeping. I was getting calls almost daily as we tried to adjust the dosage. After switching to Strattera, her attention span, behavior and school performance were soon quickly improved, and I didn't receive another call from the parents until the day they needed their refill.

The next patient I switched was a teen who just didn't like the way stimulants made him feel. He also did well on Strattera, and claimed that it helped him stay focused all day long and even into the evening.

I had similar experience with a few other patients, and while I don't plan to change all of my patients to Strattera, I do have a lot more confidence using this medicaion now and would not hesitate starting new patients on it and switching kids to it if they are having a problem with a stimulant.

Do we need a new ADHD medicine?

The stimulants, while safe and effective for many kids, only work in 70% of kids, so a new medication for treating ADHD was definitely needed.

Should you ask your doctor for Strattera?

While you shouldn't necessarily tell your doctor to prescribe Strattera for your child, it would probably be worthwhile to discuss it with your Pediatrician if you are interested in it. Remember that all kids are different, so there may be good reasons why your child shouldn't take Strattera.

Also keep in mind that Strattera, like almost any medication, can have side effects. Among the most common side effects are upset stomach, decreased appetite, nausea or vomiting, dizziness, tiredness, mood swings, and weight loss. Since these are many of the same side effects that the stimulants have, why should you try Strattera? The main reason is that although these are the most common side effects, they shouldn't happen commonly. And like kids who have side effects with one stimulant, such as Adderall XR, do fine with Concerta, just because your child has side effects on a stimulant doesn't mean that he will also have problems with Strattera.

Another issue is that it will take time for Strattera to start helping your child, so there may be a week or so where his symptoms aren't under control. This can be a problem if you try the switch around a difficult time at school.

And Strattera won't work for everyone. It is estimated that Strattera will be effective in about 70% of kids with ADHD, so there is a 30% chance that it won't work for your child.

Cost might also be an issue. Although Strattera is priced similarly to Adderall XR and Concerta, the other most commonly used once a day ADHD medications, it is more expensive than generic ritalin and adderall, although they are usually needed more than just once a day.

And one of the biggest problems is that Strattera is only available in a capsule that must be swallowed. Unlike Adderall XR, you can't simply open the capsule and sprinkle it on things for your child to eat. This limits its use in younger school age children who can't yet swallow pills.

Who should take Strattera?

Strattera is approved for all kids over age 6 with ADHD, but you might especially consider it in kids who aren't under good control on a stimulant. This would include problems at home or school, because of poorly controlled attentional problems, impulsivity and/or hyperactivity.

In addition to children who can't tolerate taking a stimulant at all, there are many other kids who are taking a lower dose than is needed to most effectively control their symptoms because of the increased side effects on higher doses of medication.

Because Strattera is not supposed to have long term effects on a child's weight gain, it would also likely be helpful for kids who don't gain weight well while taking a stimulant.

Who should not take Strattera?

There are some concerns about the effect of Strattera on a child's heart rate and blood pressure, so it might not be a good choice for children with high blood pressure, a fast heart rate (tachycardia) or cardiovascular or cerebrovascular disease. Strattera can also increase the side effects of albuterol, a medication commonly used to treat children with asthma.

If your child is doing well on a stimulant, with no or few side effects, and good control of his ADHD symptoms, then you might not want to try Strattera.

Since Stratter is new, are you experimenting if you try it?

Although a new medication, it had to undergo many years of testing before it was approved by the FDA. So while your Pediatrician will not have as much experience using Strattera as he or she has using other ADHD medications, prescribing Strattera is hardly experimenting.

Convenience

There are many once a day medications for ADHD now, so there is no novelty in giving Strattera just once a day. The biggest convenience for parents is going to be that Strattera is not a controlled substance, so you do not need to pick up a prescription from your doctor each month, like you do for stimulants. Strattera can either be written on a regular prescription pad with refills or it can be called into the pharmacy by your Pediatrician's office.

Strattera FDA Alert

The FDA has issued an alert about suicidal thinking in children and teens taking Strattera:

• Strattera may increase thoughts of suicide or suicide attempts in children and teens.
  
• Call your child’s healthcare professional right away if your child or teen has:
  
  • new or increased thoughts of suicide
    
  • changes in mood or behavior including becoming irritable or anxious
    

	Web keepkidshealthy.com

Also visit:
ADHD advice and information
Expert Pediatrician - child health and parenting advice
About Pediatrics - Expert Pediatric Parenting Advice
Father's First Year - read about Dr. Iannelli's new book