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Strattera: New Hope in ADHD Medication
By Debra Clough Stokan, M.D.
The anticipation has been tremendous. The world of child and adolescent psychiatry is hopeful that a new drug will treat Attention Deficit Hyperactivity Disorder (ADHD) without causing the side effects associated with previous medications. With its release scheduled for January 2003, we expect that the New Year will bring our patients improved treatment options. Our soon-to-be-available alternative is named Strattera (or atomoxetine HCL). Strattera gained approval by the FDA for treatment of ADHD symptoms this past November following the successful submission of six trials. More than 4,000 children, adolescents, and adults participated in these trials. Lilly and Company are continuing their study of Strattera in ongoing trials. Through these trials, Strattera has proven to be significantly more effective than placebo in treating inattentive and hyperactive / impulsive subtypes of ADHD. Patients benefited from both once and twice daily dosings. The twice daily dosings were typically timed before and after school. Trial Significance The significance of these trials is that medication other than a stimulant has proven effective above placebo in targeting ADHD symptoms. Strattera is a selective norepinephrine reuptake inhibitor. Norepinephrine has long been recognized as an important neurotransmitter for regulation of attention. Historically, researchers and clinicians have searched for other medications to target the attentional symptoms of norepinephrine as effectively as the stimulants. The benefits, if any, were disappointing. Therefore, the anticipation of a new successful option is extremely exciting. Side Effects As clinicians, we work to target the patient’s specific symptoms such as inattentiveness, hyperactivity, and / or impulsiveness with minimal side effects. With the stimulants, side effects such as initial insomnia, decreased appetite, gastrointestinal upset, sedation, moodiness, and increased heart rate can result in pre-mature cessation of therapy. In addition, the inconvenience of obtaining a triplicate form for a controlled substance each time the stimulant is refilled is often quite time-consuming and frustrating for patients and their families. Our hope is that we will see fewer side effects and improved convenience with Strattera. Although the ability to phone-in Strattera refills will definitely improve convenience, the side effect profile and efficacy must be monitored closely in each individual patient. The potential side effects listed for Strattera are thus far similar to the stimulants. They have included decreased appetite, insomnia, sedation, depression, tremor, early morning awakenings, itching, and eye focusing. Heart rate will need to be recorded at baseline, initiation of treatment, and each time the dosage is increased. Comprehensive Plan For these reasons, it will be important to meet with a physician prior to initiating Strattera treatment. Vital signs and weight need to be recorded, and possible side effects as well as target symptoms should be carefully reviewed. As with all treatment options for ADHD, the efficacy as well as side effects profile needs to be reviewed regularly with a comprehensive treatment plan established. The comprehensive treatment plan should consider the individual’s development and progress / success in family, school and social situations. Specific problems in any of these arenas are important to address as soon as identified. The Medication Corner, provided by the Tarnow Center for Self-Management, will be a featured article in each of the ADDA Newsletters. The article will provide you with the latest information and research about the medications which are being used to treat Attention Deficit Disorder. Mary Jo Taft, M.D. and Jay Tarnow, M.D. will keep you abreast of all the latest happenings in the medical community. In order for us to address your needs,, we would like to encourage you to "ask the professionals" your questions. Write the Tarnow Center for Self-Management with your questions and we will see that they are answered in each edition of the newsletter. You may contact us at: Tarnow Center for Self-Management: The Medication Corner, 1001 West Loop South #215, Houston, Texas 77027, or fax: (713)621-7015, or call: (713)621-9515. Visit the Tarnow Center web site. Become a member to receive our newsletter.
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