From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Q. My 8 year old with ADD isn't doing well. He takes 18mg of Concerta, but it isn't controlling his symptoms. On higher doses, he can't sleep, and he lost 5 pounds on Adderall XR. Would Strattera be a good medicine for him?

A. Strattera is a new non-stimulant medication that is approved to treat ADHD in kids over age 6. Since your child isn't doing well on a stimulant, he would likely be a very good candidate for Strattera.

Although many parents are concerned about trying a new medicine, there are many studies that confirm the safety of Strattera.

Still, Strattera won't work for everyone (it is estimated that it will work in about 70% of kids) and it can have side effects. The most common side effects of Strattera in children and teens is are an upset stomach, decreased appetite, nausea or vomiting, dizziness, tiredness, mood swings, and weight loss. So if your child symptoms are well controlled with a stimulant, like Adderall XR, Concerta or Ritalin, you might not want to try a new medication just because it isn't a stimulant.

Among the latest studies about Strattera (Atomoxetine) are:

• Efficacy of atomoxetine versus placebo in school-age girls with attention-deficit/hyperactivity disorder. Biederman J - Pediatrics - 01-Dec-2002; 110(6): e75

  Concluded that 'atomoxetine was found to be effective and well tolerated for the treatment of ADHD in school-age girls.'
  
  

• Results from 2 proof-of-concept, placebo-controlled studies of atomoxetine in children with attention-deficit/hyperactivity disorder. Spencer T - J Clin Psychiatry - 01-Dec-2002; 63(12): 1140-7
  
  This study 'confirmed that atomoxetine, a specific and selective inhibitor of noradrenergic uptake, was effective for the treatment of children with ADHD. In addition, atomoxetine was found to be well tolerated.'
  
  
• Once-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
  
  This study found that 'once-daily administration of atomoxetine is an effective treatment for children and adolescents with ADHD.'
  
  
• Atomoxetine 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
  
  This study provided 'preliminary evidence that atomoxetine is associated with therapeutic effects comparable to those of methylphenidate.'
  
  
• Safety profile of atomoxetine in the treatment of children and adolescents with ADHD. Wernicke JF - J Clin Psychiatry - 01-Jan-2002; 63 Suppl 12: 50-5
  
  States that 'throughout the testing phases, more than 2000 children and adolescents have been exposed to atomoxetine in clinical trials, with both the number of exposures and the length of exposure time increasing. Serious adverse events have not been clearly associated with the drug, and there have been few discontinuations due to adverse events. The most common drug-related event reported in trials has been decreased appetite and an initial period of weight loss followed by an apparently normal rate of weight gain. '
  
  
• Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study. Michelson D - Pediatrics - 01-Nov-2001; 108(5): E83
  
  Concluded that 'atomoxetine was superior to placebo in reducing ADHD symptoms and in improving social and family functioning symptoms' and 'treatment with atomoxetine was safe and well tolerated.'

Strattera Suicide Warning

Although infrequent, the FDA has warned about an increased risk of suicidal thinking in children and adolescents being treated with Strattera. Specifically, like many other psychiatric medications, the FDA states that Strattera 'may increase thoughts of suicide or suicide attempts in children and teens,' and that parents should call their child's doctor if their child has:

• new or increased thoughts of suicide
• changes in mood or behavior including becoming irritable or anxious

This warning doesn't mean that your child can't be prescribed Strattera or that he should stop taking Strattera if it is doing a good job managing his ADHD symptoms and not causing side effects. Instead, the benefit of taking Strattera should be weighed against the possible risks of the drug. And children taking Strattera should be 'observed closely for clinical worsening, suicidal thinking or behaviors, or unusual changes in behavior,' especially in the first few months of starting treatment or when the dosage is changed.