Strattera dosage, forms, and strengths

Strattera (atomoxetine hydrochloride) is a brand-name drug used to treat ADHD (attention-deficit hyperactivity disorder) in adults and children 6 years of age and older. Off-label, without an official indication, it's also used to treat cataplexy (a feature of narcolepsy characterized by a sudden loss of muscle tone) in children and adults ages 5 years and older. Strattera is a selective norepinephrine reuptake inhibitor (SNRI) that works by increasing the amount of norepinephrine and dopamine in the brain, which helps brain signals control behavior.

Strattera is taken by mouth, either once or twice daily. The dose usually starts low and is increased to higher doses over a period of four weeks, until effectiveness is achieved. Common side effects include headache, abdominal pain, nausea, constipation, dry mouth, trouble sleeping, urinary retention, chest pain, and sexual dysfunction. Serious adverse reactions include severe mood swings, psychosis, aggressive behavior, suicidal thoughts, increased heart rate (tachycardia), painful erections (priapism), and seizures. 

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Strattera forms and strengths

Strattera comes in capsule form with several strength options.

• Capsules: 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, 100 mg

Strattera dosage for adults

Strattera is FDA-approved to treat adult ADHD. It's also used off-label to treat cataplexy, a form of narcolepsy (a chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles) that causes a sudden loss of muscle tone while awake. Dosages depend on the condition being treated but typically range from 40 to 100 mg per day.

Strattera dosage for ADHD

Strattera is usually started at a lower dose and gradually increases over a period of four weeks. The standard starting dosage for adult patients is 40 mg by mouth every morning for at least three days before increasing to the standard dosage of 80 mg daily. If tolerated well, it may be increased to 100 mg per day after taking the medication for two to four weeks. Dosage may be separated into twice-daily doses in the morning and late afternoon or given as a single daily dose. Patients should continue taking the medication even if they are feeling well.

Strattera dosage for cataplexy

Strattera dosage for the treatment of cataplexy is also gradually increased over time. The standard starting dosage is a 20 mg capsule by mouth every morning for at least three days before gradually increasing to a standard dosage of 40 to 80 mg daily. Dosage may be increased up to 100 mg per day after two to four weeks. Your provider may separate the medication into twice-daily doses or give as a single daily dose.

Strattera dosage for children

An estimated 6.1 million American children (aged 2 to 17) have received an ADHD diagnosis. Strattera is FDA-approved to treat ADHD in children 6 years of age and older. The dosage depends on the child's body weight. Children weighing less than 155 pounds (70 kg) may start with 0.5mg/kg/dose every morning for at least three days before increasing to the standard dose. The standard pediatric dose for children weighing less than 155 pounds (70 kg) is 1.2 mg/kg/day taken once daily or as two divided doses. For example, a child who is 6 years old and weighs 50 pounds will start with a 10 mg capsule every morning for at least three days and then increase to 25 mg per day.

Children with ADHD who are at least 6 years old and weigh more than 155 pounds (70 kg) can take a starting dose of 40 mg by mouth every morning for at least three days before increasing to 80 mg daily. The maximum dosage after two to four weeks is 100 mg per day.

Strattera is also used to treat cataplexy in pediatric patients 5 years of age and older. Starting dosage is 10 mg by mouth every morning for at least three days. The standard total daily dose is 10 to 25 mg. The maximum dosage after two to four weeks is 100 mg per day.

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Strattera dosage restrictions

Strattera contraindications include hypersensitivity to the drug, its class, or its ingredients. Do not take Strattera if you are allergic to any of the ingredients or have had an allergic reaction to this medication in the past.

If Strattera is combined with CYP2D6 inhibitors, the dose will need to be altered. This includes medications like paroxetine, fluoxetine, and quinidine.

Those with narrow-angle glaucoma, an eye disease that causes pressure within the eye to build up, should not take Strattera.

Patients with liver disease should use caution when taking this medication. Those with a Child-Pugh Class B should decrease the initial dose by 50%. Standard and maximum dosage should also be decreased by 50% for both children and adults. Child-Pugh Class C children and adults should decrease the starting and target dose by 75%. Tell your doctor if you have any signs of liver disease including dark urine, loss of appetite, abdominal pain, or yellowing of the eyes or skin (jaundice). Liver injury has been reported, although not observed in clinical trials. Liver enzymes may be monitored during treatment.

MAOIs should be avoided within 14 days of taking Strattera due to a dangerous drug interaction that could be fatal.

Those with pre-existing hypertension (high blood pressure) should use caution when taking this medication. Strattera may increase blood pressure. Make sure your doctor is aware of your blood pressure condition and any blood pressure medication you are taking before beginning treatment.

Strattera may cause significant cardiovascular effects including tachycardia. Caution should be used in patients with underlying heart problems including heart failure or an irregular heartbeat. Although rare, sudden death has been reported in patients taking Strattera who have structural cardiac abnormalities.

Do not take Strattera if you have a history of pheochromocytoma, as it may cause serious adverse effects.

Tell your doctor if you have a personal or family history of depression, suicidal ideation, or psychosis. This medication may increase mental or emotional problems. There is an increased risk for behavioral side effects in patients with underlying mental health disorders such as bipolar disorder.

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How to take Strattera

Strattera should be taken orally, with or without food. Capsules should not be opened, crushed, chewed, or mixed in food.  Do not take more than the prescribed number of capsules in 24 hours. Follow all dosing directions and safety precautions provided by the prescribing healthcare professional.

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.

• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.

• Swallow the capsule whole. Do not crush, break, chew, or open it.

• Do not touch a broken or opened capsule. Wash your hands with water if you touch an opened capsule. If this medicine gets in your eyes, rinse them with water and call your doctor right away.

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Strattera dosage FAQs

How long does it take Strattera to work?

Strattera may take a few months to provide maximum benefits. Some symptom improvement may be seen within the first few weeks. Your doctor will tell you how long it may take to work for you. Factors such as weight, age, and metabolism can affect the effectiveness of Strattera.

How long does Strattera stay in your system?

How long Strattera stays in your system depends on how fast your body metabolizes the drug. Strattera has a half-life of around five hours in those with a fast metabolism. This means that half of the drug is eliminated from the body within five hours after ingestion, and half of the remainder is eliminated within another five hours. For those who are poor metabolizers, the drug's half-life increases to around 22 hours.

What happens if I miss a dose of Strattera?

If you miss a dose, take the missed dose as soon as you remember. If it's almost time for your next dose, wait until then to take a regular dose. Do not take two doses at once.

How long can you take Strattera?

Most people who take Strattera have been on it for many years without problems. There is no data suggesting any negative effects of using this medication long-term.

How do I stop taking Strattera?

Unlike many ADHD medications including Ritalin (methylphenidate), Strattera is not a stimulant. Because of this, withdrawal symptoms are much less likely to occur. Your doctor may or may not have you taper off Strattera when discontinuing. Research shows that those who stopped taking Strattera abruptly may have worsening ADHD symptoms, but are unlikely to experience typical "withdrawal" symptoms. Never stop taking this medication without medical advice from your healthcare provider.

What is the maximum dosage for Strattera?

The maximum adult dosage for Strattera is 100 mg by mouth per day. The maximum pediatric dosage for children at least 6 years old weighing less than 70 kg (155 lbs) is 1.4 mg per kg per day. The maximum pediatric dosage for children at least 6 years old weighing more than 70 kg (155 lbs) is 100 mg per day.

Can you overdose on Strattera?

It is unlikely that you will overdose on Strattera, but it does happen. If someone overdoses on Strattera they may experience symptoms such as drowsiness, stomach discomfort, vomiting, dizziness, tremors, or unusual behavior.

Symptoms of an overdose may appear immediately and can quickly become life-threatening. If you know someone has overdosed on Strattera call your local emergency number or the National Poison Control Helpline.

What interacts with Strattera?

Several medications affect the way Strattera works. Tell your doctor if you are taking any prescription or over-the-counter medications, including supplements and herbal products. Some medications that interact with Strattera include:

• Monoamine oxidase inhibitors (MAOI): Do not take Strattera within 14 days of stopping or starting an MAOI drug. Taking Strattera with an MAOI could be fatal. Some common MAOI drugs include isocarboxazid, phenelzine, selegiline, and tranylcypromine.

• Depression medications including paroxetine and fluoxetine may alter how the body reacts to Strattera.

• Short-acting beta 2-agonists like albuterol may affect how the body reacts to Strattera.

• Decongestants, including pseudoephedrine and phenylephrine, may affect how the body reacts to Strattera.

What happens when you mix Strattera and alcohol?

Do not drink alcohol while taking Strattera. Drinking alcohol while on this medication can cause drowsiness and low blood pressure, increasing the likelihood of serious side effects.

Is it safe to take Strattera during pregnancy?

If you are pregnant, talk to your doctor about the potential risks of taking Strattera. There have not been adequate studies to determine whether Strattera is safe to take while pregnant for breastfeeding. This medication may pass through breast milk and affect the infant. It’s unknown how Strattera affects lactation. Tell your doctor if you are pregnant, plan to become pregnant while taking Strattera, or are breastfeeding.

Related resources for Strattera dosages:

• Adult dosing, Epocrates

• Pediatric dosing, Epocrates

• Strattera patient information, FDA

• Strattera prescribing Information, FDA