STRATTERA 40MG CAPS 28S

Strattera (atomoxetine hydrochloride 40 mg) is a selective norepinephrine reuptake inhibitor (NRI) indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children aged 6 years and older, adolescents, and adults.

Atomoxetine acts by selectively inhibiting the presynaptic norepinephrine transporter (NET), thereby increasing norepinephrine concentrations in the prefrontal cortex, a brain region central to attention, impulse control, and executive function. It also modestly increases dopamine in the prefrontal cortex via secondary mechanisms.

Strattera (atomoxetine hydrochloride 40 mg) has a delayed onset of therapeutic effect compared to stimulants; full clinical benefit may take 4–8 weeks or longer to manifest. This is an important counselling point for patients and caregivers. Atomoxetine is typically used as part of a comprehensive treatment plan that includes psychological, educational, and social support measures.

Strattera capsules should be swallowed whole without opening. They can be taken with or without food. The capsule contents are irritating and must not come into contact with the eyes or skin.

Paediatric Patients (≥6 years, body weight ≤70 kg)

•     Initial dose: 0.5 mg/kg/day for a minimum of 7 days.

•     Titration: Increase to approximately 1.2 mg/kg/day (given as a single daily dose in the morning, or divided as two doses morning and late afternoon).

•     Maximum dose: 1.4 mg/kg/day or 100 mg/day, whichever is lower.

Adults and Adolescents / Children >70 kg

•     Initial dose: 40 mg/day as a single morning dose for at least 3 days.

•     After 3 days: Increase to 80 mg/day (once daily or divided into two doses).

•     After a further 2–4 weeks: May be increased to a maximum of 100 mg/day if optimal response has not been achieved.

•     No data support doses above 100 mg/day in adults.

Special Populations

•     Hepatic impairment (Child-Pugh B): Reduce dose to 50% of normal. Moderate impairment (Child-Pugh C): Reduce to 25% of normal.

•     Poor CYP2D6 metabolisers: Begin at lower doses and titrate carefully, as drug exposure is substantially higher in poor metabolisers.

•     Concurrent CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine): Start at the lowest dose and titrate with caution.

Side effects vary in frequency and severity. Not every patient will experience all listed effects. Seek immediate medical attention for any serious or unexpected reactions.

•     Suicidal ideation: A black-box warning exists in many countries (and relevant guidance in Kenya) regarding increased suicidal thinking in children and adolescents during the first weeks of treatment. Families and carers must be informed to monitor for any new or worsening mood symptoms, behavioural changes, or statements about self-harm.

•     Delayed efficacy: Unlike stimulants, Strattera may take 4–8 weeks to show full benefit. Patients and families should be counselled to continue therapy despite the absence of immediate effect.

•     Growth monitoring: Regular monitoring of height and weight in paediatric patients is recommended, as appetite suppression may temporarily impair growth trajectory.

•     Hepatotoxicity: Rare; instruct patients to report jaundice, dark urine, or right upper quadrant pain immediately.

•     Cardiac evaluation: Before initiating therapy, obtain personal and family cardiac history and conduct a physical examination. Refer for evaluation if any cardiac abnormalities are detected.

•     Tics and Tourette syndrome: Assess for the presence of tics before starting therapy; use with caution if tics are present.

The following interactions are clinically significant. Always inform your healthcare provider of ALL medicines, supplements, and herbal products you are taking.

•     MAOIs: Absolutely contraindicated; allow at least 14 days after stopping an MAOI before starting atomoxetine.

•     CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine): Markedly increase atomoxetine plasma levels; initiate at a lower dose and titrate slowly.

•     Vasopressor agents or sympathomimetics (e.g., pseudoephedrine, salbutamol): May potentiate cardiovascular effects; use with caution.

•     Antihypertensive medicines: Atomoxetine's blood pressure effects may be affected; monitor blood pressure.

•     CNS stimulants: No established pharmacokinetic interaction, but the combination may increase cardiovascular adverse effects.

Store below 25°C. Keep in original packaging. Keep out of reach of children. Do not open the capsule, the contents are irritating to mucous membranes.

Atomoxetine is not a controlled substance and does not require the same dispensing controls as stimulant ADHD medications. At the point of dispensing, counsel caregivers carefully on the delayed therapeutic onset, the importance of adherence, and the black-box warning on suicidal ideation in children and adolescents. Verify there are no concurrent MAOIs or strong CYP2D6 inhibitors. Growth parameters (height, weight) should be tracked at each prescription refill. Note that generic atomoxetine is available and is bioequivalent to Strattera; counsel on switching if cost is a concern.

Q1: How is Strattera different from Ritalin or Concerta?

A: Strattera (atomoxetine) is a non-stimulant; it does not contain amphetamine or methylphenidate, is not a controlled substance, and does not have abuse potential. It works by increasing norepinephrine rather than dopamine and takes weeks to work, unlike stimulants, which act the same day.

Q2: Can Strattera be taken by adults with ADHD?

A: Yes. Atomoxetine is approved for ADHD in both children (6 years and older) and adults. It is a good option for adults with ADHD who prefer to avoid controlled stimulant medications or have co-existing anxiety.

Q3: My child has been on Strattera for 3 weeks, but nothing has changed. Should we stop?

A: No. Strattera takes 4 to 8 weeks (sometimes longer) to reach its full effect. Stopping too early means the treatment never had a fair chance. Speak to your doctor if you have concerns, but give it the full recommended trial period.

Q4: Will Strattera cause dependence or addiction?

A: No. Atomoxetine has no known abuse liability and does not cause dependence. This makes it a preferred ADHD option in individuals with a history of substance misuse or where there are concerns about stimulant medication access.