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Overall, studies
suggest that Strattera is roughly equal in
effectiveness
to the stimulants in treating the core signs and
symptoms of ADHD, and it is generally considered
to be very safe and well-tolerated. Studies
demonstrate a graded dose response, which means
that higher doses are associated with greater
response rates. The drug also appears to have a
lower incidence of insomnia than does
methylphenidate (Ritalin (R)) and, in one
eight-week study, parents of children on Strattera
reported fewer emotional difficulties and
behavioral problems, and greater self-esteem in
their children. Parents also noted less emotional
worry and fewer lifestyle limitations for
themselves. In a year-long study in children and
adolescents,
the medication continued to be effective and
well-tolerated. Growth in children was
normal (although growth should be monitored, as it
should be with stimulants). There were mild
increases in heart rate and blood pressure which
were similar to those seen with stimulant
medications, but these were not felt to be of
clinical significance or concern for otherwise
healthy individuals, and there were no cardiac
problems or significant laboratory test
abnormalities. Another study found Strattera
to be very effective throughout the entire day and
evening, even when only administered once daily.
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The most common
side effects noted with Strattera (TM) in children
abdominal discomfort, nausea, decreased appetite,
irritability, dizziness, vomiting, and drowsiness.
When these occur, they are usually seen within the
first few days, and tend to either rapidly resolve
on their own, or can be managed with dosage
adjustment. Nausea is often eliminated by taking
the medication with food. No serious safety
concerns have yet been noted in healthy
individuals with proper administration of the
medication.
In adults, the most common side
effects are: dry mouth, insomnia, decreased appetite, nausea, constipation,
decreased
libido, and erectile dysfunction, and mild
increases in pulse and blood pressure. As in
children, these side effects can be similarly
managed, and few adults find the
side effects to be significant enough to
discontinue the medication.
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There have been few significant
adverse
interactions in healthy individuals with
medications commonly co-administered with
Strattera (even with those medications which are
known to
interact with Strattera such as ProzacR, PaxilR,
or stimulants. Oral or intravenous albuterol is not
recommended
with Strattera but the commonly used albuterol
inhalers for treatment of asthma do not appear to
present any problem. Monoamine oxidase inhibitors
such as NardilR and Pamate~ should not be
co-administered within two weeks of taking either
StratteraTM or stimulants. There are also no known
problematic interactions with food, so Strattera can generally be taken
with or without food. There are NO routine
laboratory tests required when prescribing StratteraTM
for healthy individuals. For those individuals who
have pre-existing heart, liver, kidney, or other
serious medical illnesses, StratteraTM may still
be considered, but greater caution with dosing may
be needed depending on the severity of the illness
and the specific medications being used to treat
the problem. StratteraTM should not be used in
pregnant or nursing mothers since
it
is not known if Strattera TM is excreted in human
milk, and little is
known about its use
in pregnancy. There are
exceptions
to this rule, as there are with other drugs given
what is called a “category C for pregnancy”
status, if the benefits to the mother clearly
outweigh any unknown risks to the fetus.
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3 ADHD Treatment
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