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Strattera: A Discussion on Strattera and ADHD

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It is a new medication, with a lot of publicity, and a lot of marketing money. It sounds like the best medication since antibiotics were developed. But how effective is Strattera? How does it compare to Stimulants? Or to alternatives like ATTEND?

Information on Strattera

Adapted from the Lilly FAQ page. Our comments are in italics.

Strattera is now available nationally. Strattera came out around January of 2003, and is becoming more and more popular.

In clinical trials, some patients discontinued their stimulant medications within one or two days of beginning Strattera.

Our reports are that ADHD kids who had been treated successfully with stimulants do not seem to respond as well to the Strattera as those ADHD kids who had never been treated with stimulants.

We find this true with Attend also.

Why? We think it is because even small doses of stimulants can be so effective that they "spoil" both the kids and the parents, and they want to keep taking at least a tiny dose of stimulant along with Attend or Strattera.

Strattera is a norepinephrine reuptake inhibitor, a class of ADHD treatment that works differently from the other ADHD medications available. Strattera works by selectively blocking the reuptake of norepinephrine, a chemical messenger, or neurotransmitter, by certain nerve cells in the brain. This action increases the availability of norepinephrine, which is thought to be essential in regulating impulse control, organization and attention.

See our discussion on norepinephrine here.

Take Strattera exactly as directed by your doctor. Strattera offers flexible dosing, once or twice daily. Discuss a convenient schedule for taking Strattera with your doctor.

Do not take Strattera with any other medications, even over-the-counter medications! You must talk with your doctor first! Talk to the Pharmacist too!

Our reports indicate that there can be serious problems taking anti-depressants with Strattera.

Our reports indicate that there can be serious problems taking even Benadryl with Strattera.

Our reports indicate that small doses of stimulants may be OK with Strattera, and may enhance treatment.

Strattera may be taken with or without food.

If you miss a dose, take it as soon as possible, but do not take more than your total daily dose in any 24-hour period. If possible, take Strattera at the same time every day to keep on schedule.

Strattera capsules should never be broken and sprinkled on food. They must be taken whole.

Our reports indicate that it takes 4 to 6 weeks for Strattera to work well (to reach therapeutic levels). We believe that Lilly will experience the same problems that VAXA has in getting people to stick with Attend, which also takes 4 to 6 weeks to work well. The problem is that parents usually only give an intervention 2 weeks to work, and then they move on to something else.

Stimulants, when prescribed with the correct dose, work in about 20 minutes, so parents tend to go back to using them, even with the harsher side-effects. After all, the parents don't experience the unpleasant side-effects - the kids do. But the parents do enjoy the benefits of the medication around the home.

Our reports also indicate that Strattera, like Attend, has fewer "ups and downs" than stimulants.

There can be some stomach problems, but there is less of a "rebound" effect. By the way, for reducing the "rebound" effect of stimulants, try drinking a Mountain Dew at the 3 hour mark (for Ritalin). This seems to help a great deal to eliminate the "crashing" off a dose of Ritalin, and make a smooth landing.

In one of the Strattera studies the researchers reported the following:

Adverse events did occur in some patients, including rhinitis (33.3%), headache (20%), anorexia (16.7%), and dizziness (16.7%). No serious side effects were observed and no patients stopped medication or discontinued the study due to adverse events.

There have also been reports of prostate problems in men with ADHD.

 

In each of six clinical trials, Strattera was statistically superior to placebo in reducing the symptoms of ADHD in children, adolescents and adults. The positive effects of Strattera were seen for overall ADHD symptoms including hyperactive /impulsive symptoms and inattentive symptoms.

Ummm. Coffee is better than placebo. Would you take a medication that was not better than placebo? Remember, Attend makes statistically significant improvements on the computerized TOVA CPT test in 70% of subjects, and 80% improvement on Parent Rating Scales; Ritalin makes statistically significant improvements on the computerized TOVA CPT test in 85% of subjects. Is Strattera better than these?

One of the studies [Heiligenstein J, Kaplan S, Harder D, et al.: Atomoxetine: Clinical outcomes in pediatric ADHD with comorbid ODD.] reported the following:

"The results showed that ADHD RS, CGI and CPRS ADHD Index scores from baseline to endpoint were markedly improved in patients taking atomoxetine compared to the placebo group, with no significant difference attributable to the presence or absence of comorbid ODD.

"In the atomoxetine group, clinical response was 65.4 percent for those with ODD and 58.9 percent for those without the comorbid disorder versus 36.4 percent and 29.3 percent in the placebo group (all p values less than or equal to 0.007).

"The most commonly reported treatment-emergent adverse events were headache, rhinitis and abdominal pain. Diarrhea was the only statistically significant side effect that occurred more often in children with comorbid ODD when compared with those without ODD."

It looks on the surface like Strattera may be very helpful in treating children and teens with Oppositional Defiant Disorder and ADHD. However, the results may not be as good as either Attend combined with Extress, or stimulants.

In six placebo-controlled studies, two in children, two in children and adolescents, and two in adults, Strattera significantly reduced core symptoms of ADHD, and was well tolerated. In all studies, participants met Diagnostic and Statistical Manual, 4th Edition (DSM-IV-TR), criteria for ADHD.

Eli Lilly and Company is continuing to study Strattera in short-term and long-term trials. As of October 2002, more than 4,000 child and adolescents have taken Strattera in clinical trials for ADHD.

Both Strattera and older treatments, like methylphenidate (the active ingredient in Ritalin and Concerta), are effective in treating ADHD. However, Strattera is the first FDA-approved treatment for ADHD that is not a stimulant and is not a controlled substance under the Controlled Substance Act. As a non-controlled substance, Strattera provides the convenience of physician samples and phone-in refills.

So far, parents love the fact that this is not a triplicate prescription. Doctors love this too. Ritalin is a hassle to prescribe, and a hassle to get from the pharmacy.

However, the bottom line needs to be seen in the real world. Does Strattera work better than Attend? Does Strattera work better than stimulants?

Will there be any long-term side-effects?

How long will families pay $200 a month before they switch to another treatment option?

An excellent web page on Strattera may be found here:

http://www.johnswank.com/strattera%20bw.htm

A review of the Strattera clinical studies can be found buried here:

http://www.manisses.com/

To be fair, here is a link to a site that is strongly opposed to Strattera use, as the author, Mr. Lawrence Smith, states that his child died as the result of having been prescribed medications for ADHD. He claims that there are about 20 deaths reported each year to the FDA's MedWatch program. Although it is hard to believe everything that is on the internet, I do think that you should at least take a minute to look over his site and consider the information. Here is a copy of the email that Mr. Smith sent to me in 2002.

 

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