The first studies of Strattera demonstrated one of the downsides to this medication, since unlike many of the once a day, long acting stimulants, Strattera is was given twice a day. Once a day dosing has also now been studied too though, and showed that 'once-daily administration of atomoxetine is an effective treatment for children and adolescents with ADHD.'2
And so far, none of the studies showed that Strattera works better or has less side effects than stimulants. Like the stimulants, side effects of Strattera included poor appetite, nausea, vomiting, tiredness and upset stomach. And many children lost weight in the first few months after starting Strattera. However, a few long term studies, in which children took Strattera for over a year, did show that these children did gain weight well and their height increased too. Since poor weight gain is often a problem in children taking stimulants, this finding is welcome news and Strattera may be a good alternative for these children.
Also, Strattera is metabolized through the cytochrome P450 2D6 (CYP 2D6) pathway of the liver, and so it is possible that there will be interactions with other medications, like Paxil (paroxetine), Prozac (fluoxetine) and quididine. The manufacturer also advises caution when giving a child both IV albuterol (which is rarely done) and Strattera, so this medication may not be a good choice for children with ADHD who also have asthma. And as Strattera can increase a child's blood pressure and heart rate, it should be used with caution in children with high blood pressure, a fast heart rate (tachycardia) or cardiovascular or cerebrovascular disease.
Another downside is that Strattera is only available as a capsule, and unlike Adderall XR, which can usually be opened and sprinkled on food, it is advised that Strattera be taken whole.
So while having a new treatment for children with ADHD is welcome and exciting news, until further studies have been done to show that Strattera is safer or more effective than stimulants, you shouldn't necessarily rush to your Pediatrician for a medication change.
However, Strattera may be a very good choice for children who have problems gaining weight while taking a stimulant, have other side effects, or if their ADHD symptoms are poorly controlled.
Also see our guide, Should We Try Strattera?, for more information.
References:1Atomoxetine and methylphenidate treatment in children with ADHD: a prospective, randomized, open-label trial. Kratochvil CJ - J Am Acad Child Adolesc Psychiatry - 01-Jul-2002; 41(7): 776-84
2Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study. Michelson D - Am J Psychiatry - 01-Nov-2002; 159(11): 1896-901