If your child is taking an ADHD stimulant medication and you're considering switching to non-stimulant Strattera, here are some things to keep in mind.
Many parents were excited when Strattera was introduced, especially if they didn't like the idea of giving their child a stimulant or if they were not doing well with their ADHD medicine.
There were several things that kept some kids from being switched over right away though. As a new medicine, some people were hesitant to try it in case it caused as many or more side effects as a stimulant. Others didn't like the idea of waiting the two to four weeks that Strattera takes to be effective.
Of course, if your child's current medication, whether it is Adderall XR, Concerta, or Ritalin LA, etc., is controlling his ADHD symptoms and is not causing significant side effects, like a poor appetite, poor weight gain, or insomnia, than you likely still don't want to change.
For a child who was doing well at school, making a big change and taking the risk of interfering with that success is another big reason parents stick with their child's regular medicine.
That makes summer a good time to make a switch if you or your pediatrician have been considering it. Over the summer, you will likely have more time to deal with side effects of Strattera, adjust the dosage of Strattera that your child takes, and give it time to work. And you will have plenty of time before school starts back up again to change back to his old ADHD medicine or switch to a different one if it doesn't work.
Switching to Strattera at Other Times
Waiting until summer is not always practical though. If your child is losing a lot of weight, becomes too irritable when taking a stimulant, or if they just don't seem to work, you may want to try Strattera even if it is right in the middle of the school year.
If your child with ADHD is very hyperactive, aggressive, and impulsive, and gets in trouble a lot, the idea of sending him to school without any symptom control likely doesn't sound like a good idea. In situations like this, while waiting for the Strattera to take effect, many doctors also prescribe the child's stimulant medicine to take at the same time for a few weeks. They then later stop the stimulant, continue the Strattera, and see how well it is working.
Making Strattera Work
Many people have been concerned that Strattera doesn't seem to work as well as stimulants do. Part of the reason has been that most Pediatricians were only switching their children who weren't doing well on a stimulant. Expecting these children who weren't easy to treat with a stimulant to all of a sudden do great with just Strattera likely isn't fair.
Many Pediatricians also don't have a lot of experience with Strattera yet, so they may not know to increase the dose if it isn't working, give the dose at night if it is making the child too sleepy, or change to a twice a day dose if it is causing stomachaches.
Parents and teachers also often have unrealistic expectations of a child that goes from a stimulant to Strattera. They may expect the medicine to work right away or to work in exactly the same way as a stimulant. With Strattera, although they may pay attention well and not be easily distracted, it doesn't always seem to control symptoms of hyperactivity as well as a stimulant might.
Why should you accept less symptom control when changing your child's medicine?
Well, you shouldn't if your child was doing well on a stimulant and it wasn't causing side effects. But if your child was not tolerating a stimulant, then you may have to accept the way Strattera works for your child, especially if they are getting their work done at school and aren't getting in trouble.
For many other kids with ADHD, Strattera does seem to offer symptom control that compares to a stimulant. In fact, the American Academy of Child and Adolescent Psychiatry recently introduced new ADHD treatment guidelines that listed Strattera as being a first-line treatment option.
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.