Strattera for ADHD: Pros and Cons

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If you take medication for attention deficit hyperactivity disorder (ADHD), chances are you use a stimulant medication such as Adderall, Ritalin, or Concerta. These types of medication are effective in reducing impulsivity and inattention. However, for many people, they are not an option. Side effects, such as insomnia, loss of appetite, and irritability stop them from using stimulants. Other problems are the increased risk of cardiovascular problems or interference with other medical conditions or medication.

Strattera (atomoxetine) is a non-stimulant medication approved by the FDA to treat ADHD symptoms in children, adolescents, and adults. For some, this medication has proven to be effective. Others find it is not effective at all. Just as with stimulants, Strattera also has side effects that prevent some from taking it. As with all medications, you will need to weigh the pros and cons of the medication and discuss all your treatment options with your doctor.

The Benefits of Strattera

Stimulant medications are Schedule II medications, or controlled substances, meaning that the federal government regulates how the drug is made, prescribed, and dispensed. Your doctor must write a prescription every month and you must present the written prescription to the pharmacy. Your doctor cannot call in the medication, making it inconvenient for many. Since Strattera is not a controlled sbustance, you can receive a prescription for longer than 30 days and your doctor is able to call the pharmacy to fill or refill your prescription, saving you a trip to your doctor's office each month.

Strattera is not considered to be addictive and does not have "abuse potential." Because the full effect of Strattera can take up to three to four weeks (which is later listed as a disadvantage) and it does not give a euphoric feeling, it is not used to get high. For adolescents and adults who are prone to substance abuse or addiction, this medication might be a better alternative than stimulant medications.

The medication, when taken as directed, provides 24-hour relief from symptoms of ADHD. That means, as a parent, your child will be able to complete homework in the evening and mornings might not turn into a daily power struggle because the medication is still working.

Strattera appears to have some antidepressant properties and can help those who have symptoms of depression as well as symptoms of ADHD. When taking stimulant medications, those with depressive symptoms may need to add a second medication. With Strattera that may not be needed.

This medication is often a better choice for those with Tourette's syndrome and ADHD because Strattera does not increase or aggravate tics. It also causes some urinary retention, which in some people may cause a problem but for those children with nocturnal enuresis (bed wetting), Strattera can help. Although you shouldn't use Strattera specifically for this reason, it may be an added benefit for children struggling with bed wetting.

Disadvantages

As with all medications, Strattera does have side effects. Your prescription comes with a warning about a potential for suicide when on this medication. The warning indicates that children and teens may have suicidal thoughts while taking this medication. Other side effects for children and teens include:

  • Stomach upset, nausea, vomiting
  • Loss of appetite
  • Dizziness
  • Daytime sleepiness
  • Mood swings
  • Increased heart rate and blood pressure

For adults, the most common side effects are:

  • Constipation
  • Dry mouth
  • Insomnia
  • Dizziness
  • Increased menstrual flow and cramps
  • Problems urinating or pain when urinating

Another disadvantage is that it takes three to four weeks of sustained used to reach full effectiveness. There may be a number of people that start this medication and give up before waiting a month to decide if it works. Some individuals with ADHD choose to take medication only as needed, when focus and attention are required for a period of time, and to not take it on days when concentration isn't required. If this is best for you, Strattera isn't an option. Stimulant medications would be best.

Some men have complained of sexual side effects from Strattera, including a decreased sex drive, impotence, decreased ejaculation amount, or the inability to ejaculate and painful erections.

If you are having any side effects, including sexual side effects, from Strattera, talk with your doctor. Sometimes adjusting the dosage can help alleviate the side effects. In some cases, your doctor might suggest lowering your dosage or trying a different medication.

References:

Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders. Neurology, 2005, A.J. Allen et al,  65(12): 1941-1949

Highlights of Prescribing Insert for Strattera, Revised 2011, Mar, 7, Eli Lilly and Company