Posted by not exactly on January 24, 2003, at 6:57:13
In reply to Re: Strattera Allergic Reaction, posted by golfergman on January 23, 2003, at 10:26:10
> Yesterday I took my first dose of straterra 18mgs. Im 47 year old male and I know this is a very small dose. My first day I would have to say Im rather down about the whole ADD thing. I definetly felt an affect. I felt high as a kite and didnt like it at all. My Dr. wants to start out with small doses for 4 days. My feeling is I dont know if I can handle this. Im not taking it today because it made me edgy, uptight, couldnt sleep at night. In other words I didnt feel good about it. The same thing happened when I tried Ritalin. Does anyone have some insight or similar experiences. I feel rather down about the whole thing. I guess I'll just have to live with this the rest of my life.
I can sympathize with your reaction. You might be hypersensitive to certain kinds of drugs. I know I am - if I start taking almost any psychoactive drug at a "normal" dosage level, it will send me up the wall. I haven't tried Strattera (not yet, anyway, but I may soon - that's why I'm reading the Strattera posts), but I'm definitely hypersensitive to Ritalin. If I took 10 mg of Ritalin 3 times day (a typical adult dosage), I'd be "wired", irritable, unable to sleep, and convinced it was a "bad" drug. But if I take only 1.25 to 2.5 mg (1/4 to 1/2 of the lowest dose "kiddie" pill) twice a day, I have found it to be very beneficial.
One possibility is that you are a "poor metabolizer" of Strattera. According to the prescribing info:
"A fraction of the population (about 7% of Caucasians and 2% of African Americans) are poor metabolizers (PMs) of CYP2D6 metabolized drugs. These individuals have reduced activity in this pathway resulting in 10-fold higher AUCs, 5-fold higher peak plasma concentrations, and slower elimination (plasma half-life of about 24 hours) of atomoxetine compared with people with normal activity [extensive metabolizers (EMs)]."
The 10-times greater AUC ("Area Under Curve" of the graph of level vs. time, a measure of total drug exposure) is an extreme case of "Your Mileage May Vary"! Oddly enough, they don't give any dosing guidelines if this condition is present (or suspected). I would think that you'd need to take 1/5 of the usual amount half as often in order to get the same level of drug activity that "normal" (EM) folks experience. This translates to 8 mg (10 is the smallest cap they make, probably close enough) once a day as the TARGET dosage; a conservative approach would be to start with half that amount and slowly ramp up! So even though your 18 mg is "a very small dose" it could still be way too much FOR YOU.
Given your reaction, skipping the next day's dose was the right move. Have the negative effects worn off yet? If you're feeling OK in a day or 2, here's what I would do:
Open an 18 mg cap and take only 1/4 of the contents (4.5 mg). If the side effects are tolerable (e.g. sleep is possible), continue taking this amount once a day for a few days. Then slowly increase the dose, a tiny bit more every few days, until either you notice a benefit or the side effects are too much.
[Disclaimer: I'm a chemist, not a doctor. I can't guarantee this will help, or even be completely safe. Don't follow this advice if you're not comfortable with it. Talk to your doctor first.]
Remember that the full beneficial effect might take a week or 2 to kick in, while the side effects (especially those resulting from taking too much too soon) will be evident almost immediately and should diminish over time as your body adjusts. But there's always the possibility that this is simply the wrong drug for you - too many side effects for too little benefit, even with a very cautious dosing schedule. Significant side effects that don't improve with time and worsen dramatically with every small dosage increment indicate an allergic reaction or other incompatibility, and the drug should be discontinued.
BTW, I'm concerned by your closing comments: "I feel rather down about the whole thing. I guess I'll just have to live with this the rest of my life." Of course, this sort of pessimism can result from repeated treatment failures. Have you tried numerous ADD medications with no benefit?
But you might also be suffering from depression along with your ADD. I know what this is like - I have both of these problems (plus others). Sometimes depression can diminish concentration & motivation, and hence be mis-diagnosed as ADD. Have you tried any antidepressants? You might find one of the mildly-stimulating antidepressants, such as Wellbutrin or desipramine, to be helpful. Given your reactions to Ritalin & Strattera, I'd recommend that you start with no more than 1/2 the usual dosage.
Good luck, and let us know how you're doing.
- Bob
poster:not exactly
thread:133458
URL: http://www.dr-bob.org/babble/20030119/msgs/137299.html