Dr James Schaller
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A New Treatment for ADHD & ADD: STRATTERA

For years I have been looking for medicines and nutrients to help those with AD/HD or other attention problems. Most of the new medications were merely improvements of stimulants we have had for many years. In the 1990's, I heard about this medication and was pleased to see it showed good promise. In fact, it was being studied in animals in the mid-80's.

Over the years, I contacted the maker a number of times and never received a response as to its status. Then after assuming it was gone, perhaps due to some possible side effect, I start seeing rare articles published on its benefits in ADHD. And then suddenly it arrived in the pharmacy one week.

So why even look at this medication? It acts by a specific and new mechanism: blocking norepinephrine.

Strattera is a selective norepinephrine reuptake inhibitor, and it works differently from the other ADHD medications presently available.

Strattera is the first non-stimulant medication "approved" by the FDA for the treatment of ADHD in children, adolescents, and adults.

Of course, Wellbutrin has been used successfully for years at higher doses for ADD/ADHD, but they never did massive studies to gain FDA approval. According to Paul Wender MD, a leading ADHD medication researcher, in an interview with me in the early 1990's, he found that one need higher doses of Wellbutrin, e.g., 350-450 mg a day (divided into separate doses), to see an ADD/ADHD effect. This mirrors my experience.

Also, when youth on Strattera were rated on benefits in treating ADHD symptoms, it appeared that virtually all patients have a full day benefit. Meaning, once a day is an effective dose.

It is unlikely to be abused, since abusive and excess doses appear to merely make a person feel ill.

Like most medications, people can have side effects when they start. Usually this is because the starting dose during the first three days is too high. The recommended starting dose for 80% of psychiatric medications for day one is too high in my opinion.

They figure some "mild" side effects are OK, if they go away in a few days or week. I disagree.

Side effects for this medication include:

  • nausea
  • decreased appetite
  • constipation
  • dry mouth
  • vomiting
  • problems urinating
  • menstrual cramps
  • tiredness
  • stomach aches
  • sleep changes
  • dry mouth
  • decreased appetite
  • dizziness
  • sexual functioning changes
  • increased pulse or heart beat
  • increased blood pressure

It is important you do not have narrow angle glaucoma if you are taking this medication -- a fairly common form of increased eye pressure when using this medication in which the draining and moving front eye fluid is moving poorly. It you have this disorder or are borderline, this medication could put you over the edge—it could get worse and seriously hurt your eye. Get your eyes checked before you start this medication, and once you reach your final dose.

How do you know if this is happening to you? I would only trust a physician with experience diagnosing glaucoma. But often it can come on with eye pain, nausea and perhaps even vomiting. Your eye may be red, sight might be blurry and you might see a halo around a bright light. Do not assume if this goes away, you do not have it. Apparently, in some people, these symptoms do come and go as pressure goes up and down! It could cause blindness in 1-2 days.

However, in the real world, not treating ADHD/ADD can result in physical and educational and social problems—not the least is car accidents and fractures. Also, in the thousands of youth that have been treated, the most common problem was a decreased appetite and an initial period of weight loss, followed by an apparently normal rate of weight gain. This happens early in treatment and usually declines.

Mild increases in blood pressure and pulse usually do not continue to rise, and it is rare for the medication to be stopped due to either.

To my knowledge, there have been no signs of cardiac pacemaker changes. The most common in some medications is a change to the "QT interval." But I have not seen evidence yet that this is a problem.

One doctor once said that this medication "had no major drug interactions." However, it is very likely they exist--even if they are not a common problem.

Simply, the liver uses different catcher's mitts to catch different drugs and substances and remove them. The one that catches Strattera is the CYP2D6 glove.

Here is the problem with blindly dosing. This 2D6 enzyme is very different from one person to another. One person has a lot and some people very little. So the drug can be 50% removed in 5 hours or 20 hours—it depends on how much 2D6 is chewing it up.

A good reason to start at the lowest possible dose, in case it hangs around for a long time.

Also, many other medications use this 2D6. So your doctor should be aware of the drugs you are on and check.

Since most doctors are being sued and worked to a frazzle, they might not be able to always check. So you should log on to: medicine.iupui.edu if you want to be extra sure. Also, an interaction is not always a serious interaction. Changing a drug level in the blood 5% is an interaction—but it usually is trivial.

This medication should not be casually mixed with Selegiline, Parnate, Nardil or Moclobemide (available outside the USA). These MAO Inhibitors might cause a reaction. Usually, only a psychiatrist or neurologist would prescribe these medications. But Selegiline is useful in Parkinson's disease and other doctors might prescribe it.

It is possible that increasing norepinephrine might cause blood sugar levels to rise, but I do not have any evidence of this yet with this specific medication.

Strattera probably helps with bed wetting problems in youth.

James L. Schaller, MD, MAR
Naples, FL

Bank Towers, Tamiami Trail, Naples, FL
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