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Dr. Bob is Robert Hsiung, MD,
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Posted by sjb on February 7, 2003, at 11:49:16
In reply to Anybody else sedated on Straterra? Please respond, posted by Cindylou on February 7, 2003, at 7:13:57
I certainly did and stopped it after 6 days. Still oversleeping and overeating. Does anyone know what that half life is?
Posted by not exactly on February 7, 2003, at 13:00:44
In reply to Re: Anybody else sedated on Straterra? Please respond, posted by sjb on February 7, 2003, at 11:49:16
> Does anyone know what that half life is?
short answer: typically 5 hours, but can be as much as 24 hours
long answer, from the official "prescribing information" document:
Human Pharmacokinetics
Atomoxetine is well-absorbed after oral administration and is minimally affected by food. It is eliminated primarily by oxidative metabolism through the cytochrome P450 2D6 (CYP2D6) enzymatic pathway and subsequent glucuronidation. Atomoxetine has a half-life of about 5 hours. A fraction of the population (about 7% of Caucasians and 2% of African Americans) are poor metabolizers (PMs) of CYP2D6 metabolized drugs. These individuals have reduced activity in this pathway resulting in 10-fold higher AUCs, 5-fold higher peak plasma concentrations, and slower elimination (plasma half-life of about 24 hours) of atomoxetine compared with people with normal activity [extensive metabolizers (EMs)]. Drugs that inhibit CYP2D6, such as fluoxetine, paroxetine, and quinidine, cause similar increases in exposure.[the complete document can be downloaded from http://pi.lilly.com/us/strattera-pi.pdf]
- Bob
Posted by Cindylou on February 7, 2003, at 13:05:04
In reply to Re: Anybody else sedated on Straterra? Please respond, posted by dancingdp on February 7, 2003, at 9:27:03
Thanks everyone for your responses! Dancin, thanks for the suggestion of taking a lower dose. My pdoc is hard to get into, and hard to get in touch with (I am looking for a new one, obviously!) I wonder if, in the meantime, I could just open up the capsule and dump out half?
Thanks again,
cindy
Posted by Cindylou on February 7, 2003, at 13:09:43
In reply to Re: Anybody else sedated on Straterra? Please respond, posted by Cindylou on February 7, 2003, at 13:05:04
I just got an answer on another thread about dumping out the capsule. (Sounds like it's worth a try!)
Thanks again to everyone.
cindy> Thanks everyone for your responses! Dancin, thanks for the suggestion of taking a lower dose. My pdoc is hard to get into, and hard to get in touch with (I am looking for a new one, obviously!) I wonder if, in the meantime, I could just open up the capsule and dump out half?
>
> Thanks again,
> cindy
Posted by HADD Enough on February 7, 2003, at 15:02:44
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
I'm now at 60mg/day and still doing great! The side effects I've had so far (upset stomach, constipation) are minor and disappear after a couple of days. They came back for a little bit when I upped the dosage from 40 to 60mg, but I suspect that they will diminsh in time. I saw my pdoc yesterday and told him how much better my concentration, focus and mood have been and discussed my major concern...namely that the drug's effectiveness will diminish over time. He indicated to me that from the clinical trials, and from anecdotal evidence he has heard from his colleagues that the drug's action tended to get better over time (6 months) rather than diminsh. All I know is that, for me, this continues to be a miracle drug!
I'm working with my pdoc to tweak the dosage until I get maximum benefits at minimum dosage. He told me that Lilly has modified their max dosage recommendations from 100mg/day for adults to 80 mg/day. My pdoc said that I could remain at 60mg/day or try to go to 80 when I feel ready. I'm going to stay at 60 for a couple of weeks, and then try 80. If there is no marked difference, I'll probably go back to 60 and settle there, but if 80 is better then I'll stay at 80.
I'll update again in a week or earlier if there is anything else major to report.
Cheers,
HADD Enough
Posted by bennett on February 7, 2003, at 15:30:55
In reply to Re: Anybody else sedated on Straterra? Please resp » dancingdp, posted by mshyper on February 7, 2003, at 10:32:31
Sedation? Oh yes. Only with food? Oh yes!
2nd day - 5 hours after taking 18 mg – middle of the afternoon, I had to lay down – two hours later I woke up still tired
I’ve experienced this off and on since then – and it doesn’t seem to be related to lack of sleep.
High side of this is that I’m weaning myself off of Ambien because I don’t seem to need as much as I used to to get to sleep – and I’m hoping I can get by with out it. By 11-11:30 I’m pretty tired and ready for bed – that’s very unusual for me. 2-3 AM has been my normal “bed time” ever since I had a choice in such things.
Dizziness (if I smoke a cigarette) and sedation are the two side effects I’ve experienced the most so far.
The stimulants I’ve taken in the past had a similar sedative effect. Ritalin and Dexedrine calmed me down so much, I would sometime fall asleep in the afternoon. But by night time I was on a roll and had to knock myself out to get to sleep.But I’m very happy to say that the strattera finally started to help with focus and ADD sx.
I nursed the dose from 18 mg/day, to 18am/18pm with no positive effects. It wasn’t until I took 2 -18 mg caps on the morning of the 8th day that I noted some very positive effects. And on day 9, when I moved both AM and PM doses to 36 mg (I only have 18 mg caps) I began to see results very similar to when I used to take stimulants.
I had to get off Dexedrine about two years ago and went on wellbutrin.
The welbutrin helped in a sideways kind of way by stabilizing my mood so I was able to be quiet enough to attend better but it didn’t help the focus at all. I had to leave my job as a result of this shift in medication – I’d moved into administrative duties that my un-medicated ADD self was entirely unsuited for.I’m on day 12 now, and very pleased with the Rx as far as some ADD sx are concerned. I’ve started finishing old projects (the kind that require reading lists and numbers that I'm not particluarly interested in - but that I really need to get done) that have been sitting around forever.
Yesterday, I found myself going through my running 2 year old to-do list updating it to the present. Without Rx. I cannot get myself to look back at the undone items in a list without getting sidetracked and not getting back to what I was in the middle of when I started.
However, if I were still working in the office I used to work in, the side effects I’ve experienced so far probably would have precluded my staying with it.For instance, this morning I took the dose 1/2 hour before breakfast and an hour later was so nauseous and dizzy that I had to lie down. I spent the next hour and a half on the couch trying to stay centered and quiet till it passed.
Then, as suddenly as the nausea and dizziness came on –it was gone – and I felt fine. I opened my eyes, got up and started working. Fortunately I was at home during all of this.
I won’t take this without food again.
Well, that’s my story so far.My sweetie is coming to visit this weekend and I’ll get to see if the socially interactive sx. have improved. I still talk a lot, but I seem not to interrupt as much. In any event, she’ll let me know since she has seen them at their worst (and their best) over the years.
We’ll be at a festival with lots of people and booths screaming for my attention. If I find I can keep a conversation going with her while we’re walking along – without stopping mid-sentence to talk to someone else or getting totally distracted by something I see … ...
She’ll let me know how this stuff is working….
By the way I'm a 61 yr old male diagnosed ADD in 1992.
thanks,
bennett
Posted by harper on February 7, 2003, at 18:30:16
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
My 13 year old daughter has been on 40 mg for the last month. The ADD is much better and she's had no side affects except for sleepiness and an upset stomach the first couple of days. The only problem now is her terrible and increasing moodiness.
Even though I think puberty has something to do with the moodiness, I think she needs an antidepressant along with the Strattera.What antidepressants are others taking with this med? Since this is a new med, her doctor doesn't have any experience with this one (even though he is a big shot at NIMH in child psychiatry!), I want to give him suggestions.
I understand some people are on Wellbutrin with this med. How much and how is it working?
Please respond.
Posted by ShelliR on February 7, 2003, at 19:31:32
In reply to Straterra , posted by harper on February 7, 2003, at 18:30:16
Posted by Cindylou on February 7, 2003, at 21:06:10
In reply to Straterra , posted by harper on February 7, 2003, at 18:30:16
Hi Harper,
I noticed in an earlier post that a teenager on Strattera also had increased moodiness ... it's so hard to tell with all those hormones raging what is causing what.I am taking Lexapro, and so far it is the only antidepressant I've been able to tolerate. My pdoc said the combo of Lexapro and Strattera is fine. (As for my experience, I have only taken Strattera for one day. I was extremely sedated and haven't had the guts to try it again. I am quite confident that the sedation didn't have anything to do with the combo of the meds, however, since I am very med-sensitive and I react strongly to medications across the board.)
Lexapro is an SSRI, like Prozac, but has much fewer side effects. It's quite new, so the drawback is that it's not as "tried and true" as Prozac.
Best of luck to you and your daughter. I had a tough time when I was 13 ... my heart goes out to her and to you!
cindy.
> My 13 year old daughter has been on 40 mg for the last month. The ADD is much better and she's had no side affects except for sleepiness and an upset stomach the first couple of days. The only problem now is her terrible and increasing moodiness.
>
> Even though I think puberty has something to do with the moodiness, I think she needs an antidepressant along with the Strattera.What antidepressants are others taking with this med? Since this is a new med, her doctor doesn't have any experience with this one (even though he is a big shot at NIMH in child psychiatry!), I want to give him suggestions.
> I understand some people are on Wellbutrin with this med. How much and how is it working?
> Please respond.
Posted by mom2mbcb on February 8, 2003, at 5:43:19
In reply to Re: Straterra » harper, posted by Cindylou on February 7, 2003, at 21:06:10
day 3 of straterra, I noticed slight ( very slight ability to focus , wasnt sure it was working , this was day 2 on 18 mg straterra on feb 6 , feb 7 i felt much beter in the a.m but by evening I felt wound up again..to a much higher degree than i thought i was prior to strattera, I read the drug doesnt cause rebound, would a higher dose make it last longer, seemed to last from about 6 am to about 2 am ...I dont want to be a roller coaster. what do you think. My adhd doc wants me to stay at 18 mg for a month..i thought titration was every 3 day to a week...
Deb
Posted by not exactly on February 8, 2003, at 11:25:42
In reply to Re: Straterra » Cindylou, posted by mom2mbcb on February 8, 2003, at 5:43:19
Deb,
Strattera half life is typically 5 hours. If the good effects wear off too quickly, going to b.i.d. or increasing the dose should help. Waiting a month before dose adjustment seems way too conservative.
- Bob
Posted by mom2mbcb on February 8, 2003, at 15:23:15
In reply to Re: Straterra » mom2mbcb, posted by not exactly on February 8, 2003, at 11:25:42
Thank you for your response. I was dissappointed as today day 4 I did not even have any positive effects and felt wound up all day as my usual adhd self does, also I noticed yesterday but more so today i get really sleepy on it, i took it a 6 am and absolutley had to sleep about 2:00 p.m. and wqas out to the world until 4:30 p.m. Is this a usual side effect. I really wanted this stuff to work as i couldnt tolerate side effects of stims. The adderral worked wonders for my focus but i felt realy driven. Iwould kill for that one thought and one thing at a time ability aderral gave me. Any advice would help as I am upsetting myself. I dont know if the pill is making me feel a little down in the dumps or my attitude.
Deb
Posted by not exactly on February 8, 2003, at 16:08:59
In reply to Re: Straterra, posted by mom2mbcb on February 8, 2003, at 15:23:15
How long has it been since you discontinued stim use? Some of your current negative symptoms could be due to stim withdrawal/rebound.
- Bob
Posted by mom2mbcb on February 9, 2003, at 4:11:58
In reply to Re: Straterra » mom2mbcb, posted by not exactly on February 8, 2003, at 16:08:59
well Its been quite a while at least 2 months. I hate to asound so negative, but I'm really trying to stick this one out.. But since I had posted about my feeling down in the dumps it had gradually increased by evening to an uncomfortable depression which I'm generally NOT ACCUSTOMEND TO EXCEPT ( EXCUSE ME MEN) around pms. And even then its not quite this bad. I dont want to quit thiS EARLY in the game if i can stand it . Does anyone know whether this pill is easy to get off If I find I need to. Also All my posts have been around 4 am I get to bed around 12 pm so I am waking up too early also. I normally only have anxiety like symptoms whivh really only show up with the adhd wind up or a too much to do at one time or to much over stimulation of outside necesseties.
Deb
Posted by Phil on February 9, 2003, at 18:51:33
In reply to Re: Straterra » not exactly, posted by mom2mbcb on February 9, 2003, at 4:11:58
No tapering required to stop Straterra.
Posted by paulk on February 9, 2003, at 19:35:22
In reply to Re: Straterra » not exactly, posted by mom2mbcb on February 9, 2003, at 4:11:58
What dosage are you taking? I'm starting out on a very low dosage (10mg) all I notice so far is possibly some iritability and I wake up a bit earlier.
Posted by mom2mbcb on February 10, 2003, at 3:48:38
In reply to Re: Straterra, posted by paulk on February 9, 2003, at 19:35:22
well I started on only 18 mg. Fianl update. I will not take it this morning. Yesterday i was a mental mess and Slept off and on in a fog most of the day. Felt a bit better by 8:00 p.m up today at 4:00 a.m. I have decided this is NOT going to work, So I will do my best to educate myself on behavior and cognitive therapy. Restructuring, Since i started with meds I have had side effects much worse ( although i find adhd makes my life very difficult with a 2 yr old and a 1 year old and very hard in other aspects as well) But I cant deal with the added significant side effects. I am disappoint4ted as i did get a chance to enjoy mental singlemindedness on adderrall, justhad to many physical side effects
Thanks everyone
Deb
Posted by dancingdp on February 10, 2003, at 7:08:27
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 3:48:38
Hey Deb,
It sounds like you are ultra sensitive to meds in general. Here is my advise to you. If you really want to give the Stattera a fair try I suggest you take only 10 mg. to start for a week. Then I would increase the dose SLOWLY! You know your system the best. I know that it is supposed to go by weight but I have found that every one is different and if you are at all sensitive than it may take you longer to reach a thereputic level. Talk to your pdoc about it. Take it or leave it. This is my advise from much experience. Good luck!!! dancing
Posted by paulk on February 10, 2003, at 8:50:35
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 3:48:38
> well I started on only 18 mg. Fianl update. I will not take it this morning. Yesterday i was a mental mess and Slept off and on in a fog most of the day. Felt a bit better by 8:00 p.m up today at 4:00 a.m.
I just started on 10mg/day (at 200lbs) and think it would have been a big mistake to have started on a higher dosage. After the second day I was having sleep problems and felt shaky. If I had started at a higher dosage I would of been a mess.
from the monograph:
"... A fraction of the population (about 7% of Caucasians and 2% of African Americans) are
poor metabolizers (PMs) of CYP2D6 metabolized drugs. These individuals have reduced activity
in this pathway resulting in10-fold higher AUCs, 5-fold higher peak plasma concentrations,
and
slower elimination (plasma half-life of about 24 hours) of atomoxetine compared with people
with normal activity [extensive metabolizers (EMs)]..."Because of the wide difference in bloodlevel, I (I'm not a doc) would suggest anyone starting atomoxetine(Straterra) to think about starting with a very low dosage. I'm puzzled as to why the remmendations aren't different in the monagraph? Perhaps because it is only labled for children that would tend to be higher metabalizers?
Posted by mom2mbcb on February 10, 2003, at 10:37:40
In reply to Re: Straterra, posted by paulk on February 10, 2003, at 8:50:35
Thanks everyone. Yeah, I hate it that I am sensitive to meds.WOULD GIVE ANYTHING FOR THJE ADERRAL. i WOULD NEVER HAVE known how normal people think one thought at a time and then to have to go off of it and be like this again, Anyway it caused my usual 90/60 b/p to go to 156 /110 and My chest got tight and my arm went numb...tried lowering the dose to 7mg then to 5 still no relief form side effects. Man, I guess i just gotta get used to this and stop ther self pity and try to figure it out. Its hard because situation to situation daily changes and if i only had me to tend to i could do the routine thing, but since having 2 toddlers There is no predicatablity and i cannott sort all the calls for my attention and it changes daily and i get informTION, DEMAND FOR MY ATTENTION and sound overload. Sorry for the details. I'm just really discouraged. I didnt get this mood change thing with the stims that straterra did and THe thought of even taking 10 scares me, I dont want to add this moodiness on top of my anxiety/disorganized forgetful, butterfly ,pinball brain. I am glad to have yalll to discuss it with , i lurked for days before i decided to try straterra. i MUST BE A poor metabolizer I STILL FEEL STRUNG OUT /MOODY. HOPEFULLY THAT WILL IMPROVE
DEB
Posted by Peter S. on February 10, 2003, at 11:34:29
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 10:37:40
I started on Straterra at 10mg for 2 days and went up to 20mg. I've noticed an increase in irritability (also apparent at 10mg) which is extremely unpleasant- although I have had more energy. My mood has been pretty bad and I think worse than before. I really want to stop, but I want to make sure that I'm giving it a fair trial. I'm also taking Lamictal and Neurontin.
I wish there was more data on whether the irritablity goes away in time. I really have difficulty tolerating it. Sounds like some other people are having same effect. Has anyone noticed it going away?
Any psychopharmacologists know why Straterra might cause irritability? Does norepinephrine cause irritability? I was thinking that maybe if it's not balanced out with other neurotransmitters (like serotonin)it might do this. What about combining it with an SSRI? God I hate brain chemistry!
Posted by not exactly on February 10, 2003, at 12:43:38
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 10:37:40
Deb,
I agree with the posts by dancingdp and paulk. It's very likely you are one of those "poor metabolizers", and need to reduce your dosage accordingly [see http://www.dr-bob.org/babble/20030119/msgs/137299.html]. This might also explain the problems you've had with other meds. I, too, am very sensitive to most drugs, and have found that my optimal dosage is usually 1/2 (and sometimes as low as 1/10!) the amount that "normal" folks require.
Since Adderall helped but had serious s/e problems, you might want to try good ol' plain dexedrine instead. The l-amphetamine isomers (present in Adderall but not dex) can rub some people the wrong way (myself, for example) and may have been responsible for the high BP. But whatever you do, start with TINY doses. I find that as little as 1 mg/day of dexedrine can be a big help.
Another med you might want to try (in tiny doses, of course) is Ritalin.
BTW, your "usual" BP of 90/60 seems REALLY LOW. What does your pcp think of this?
- Bob
Posted by Dog Breath on February 10, 2003, at 14:53:10
In reply to Re: Straterra, posted by paulk on February 10, 2003, at 8:50:35
It amazes me how people react so differntly to meds. I must be at the far end of the scale. I am on day 19 of Straterra along w/20mg Lexapro and I can't say I have felt anything! I've heard others talk about a "brightening" of mood and increased focus. I'm at 80mg for the last 7 days but It hasn't made any difference. Has anyone else had this reaction? Is 19 days not long enough?
D
Posted by paulk on February 10, 2003, at 17:00:20
In reply to Straterra irritablity, posted by Peter S. on February 10, 2003, at 11:34:29
> I started on Straterra at 10mg for 2 days and went up to 20mg. I've noticed an increase in irritability (also apparent at 10mg) which is extremely unpleasant- although I have had more energy. My mood has been pretty bad and I think worse than before. I really want to stop, but I want to make sure that I'm giving it a fair trial. I'm also taking Lamictal and Neurontin.
>
> I wish there was more data on whether the irritablity goes away in time. I really have difficulty tolerating it. Sounds like some other people are having same effect. Has anyone noticed it going away?
>
> Any psychopharmacologists know why Straterra might cause irritability? Does norepinephrine cause irritability? I was thinking that maybe if it's not balanced out with other neurotransmitters (like serotonin)it might do this. What about combining it with an SSRI? God I hate brain chemistry!
>
Why not go back to 10mg/day - at least until the iritability goes away?
Norepinephrine can do that - you may want to take it with food to limit the peak blood level a bit - smooth things out. I take it you read how for 10% of the population it is 5 times more powerful.This is my first day at 20mg - Seems to be pretty good.
Posted by paulk on February 10, 2003, at 17:04:51
In reply to Straterra-Nothing » paulk, posted by Dog Breath on February 10, 2003, at 14:53:10
As is in the earlier posts - It appears that this drug has a wide range on blood level depending on your genes. You may just need more. I would say if you can't tell you are taking it after 2 - 5 days you probably arn't taking enough. I could tell it was doing something the second day on 10mg. For you, that same blood level could be the same at 50mg.
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