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Dr. Bob is Robert Hsiung, MD,
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Posted by mom2mbcb on February 10, 2003, at 3:48:38
In reply to Re: Straterra, posted by paulk on February 9, 2003, at 19:35:22
well I started on only 18 mg. Fianl update. I will not take it this morning. Yesterday i was a mental mess and Slept off and on in a fog most of the day. Felt a bit better by 8:00 p.m up today at 4:00 a.m. I have decided this is NOT going to work, So I will do my best to educate myself on behavior and cognitive therapy. Restructuring, Since i started with meds I have had side effects much worse ( although i find adhd makes my life very difficult with a 2 yr old and a 1 year old and very hard in other aspects as well) But I cant deal with the added significant side effects. I am disappoint4ted as i did get a chance to enjoy mental singlemindedness on adderrall, justhad to many physical side effects
Thanks everyone
Deb
Posted by dancingdp on February 10, 2003, at 7:08:27
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 3:48:38
Hey Deb,
It sounds like you are ultra sensitive to meds in general. Here is my advise to you. If you really want to give the Stattera a fair try I suggest you take only 10 mg. to start for a week. Then I would increase the dose SLOWLY! You know your system the best. I know that it is supposed to go by weight but I have found that every one is different and if you are at all sensitive than it may take you longer to reach a thereputic level. Talk to your pdoc about it. Take it or leave it. This is my advise from much experience. Good luck!!! dancing
Posted by paulk on February 10, 2003, at 8:50:35
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 3:48:38
> well I started on only 18 mg. Fianl update. I will not take it this morning. Yesterday i was a mental mess and Slept off and on in a fog most of the day. Felt a bit better by 8:00 p.m up today at 4:00 a.m.
I just started on 10mg/day (at 200lbs) and think it would have been a big mistake to have started on a higher dosage. After the second day I was having sleep problems and felt shaky. If I had started at a higher dosage I would of been a mess.
from the monograph:
"... 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 in10-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)]..."Because of the wide difference in bloodlevel, I (I'm not a doc) would suggest anyone starting atomoxetine(Straterra) to think about starting with a very low dosage. I'm puzzled as to why the remmendations aren't different in the monagraph? Perhaps because it is only labled for children that would tend to be higher metabalizers?
Posted by mom2mbcb on February 10, 2003, at 10:37:40
In reply to Re: Straterra, posted by paulk on February 10, 2003, at 8:50:35
Thanks everyone. Yeah, I hate it that I am sensitive to meds.WOULD GIVE ANYTHING FOR THJE ADERRAL. i WOULD NEVER HAVE known how normal people think one thought at a time and then to have to go off of it and be like this again, Anyway it caused my usual 90/60 b/p to go to 156 /110 and My chest got tight and my arm went numb...tried lowering the dose to 7mg then to 5 still no relief form side effects. Man, I guess i just gotta get used to this and stop ther self pity and try to figure it out. Its hard because situation to situation daily changes and if i only had me to tend to i could do the routine thing, but since having 2 toddlers There is no predicatablity and i cannott sort all the calls for my attention and it changes daily and i get informTION, DEMAND FOR MY ATTENTION and sound overload. Sorry for the details. I'm just really discouraged. I didnt get this mood change thing with the stims that straterra did and THe thought of even taking 10 scares me, I dont want to add this moodiness on top of my anxiety/disorganized forgetful, butterfly ,pinball brain. I am glad to have yalll to discuss it with , i lurked for days before i decided to try straterra. i MUST BE A poor metabolizer I STILL FEEL STRUNG OUT /MOODY. HOPEFULLY THAT WILL IMPROVE
DEB
Posted by Peter S. on February 10, 2003, at 11:34:29
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 10:37:40
I started on Straterra at 10mg for 2 days and went up to 20mg. I've noticed an increase in irritability (also apparent at 10mg) which is extremely unpleasant- although I have had more energy. My mood has been pretty bad and I think worse than before. I really want to stop, but I want to make sure that I'm giving it a fair trial. I'm also taking Lamictal and Neurontin.
I wish there was more data on whether the irritablity goes away in time. I really have difficulty tolerating it. Sounds like some other people are having same effect. Has anyone noticed it going away?
Any psychopharmacologists know why Straterra might cause irritability? Does norepinephrine cause irritability? I was thinking that maybe if it's not balanced out with other neurotransmitters (like serotonin)it might do this. What about combining it with an SSRI? God I hate brain chemistry!
Posted by not exactly on February 10, 2003, at 12:43:38
In reply to Re: Straterra, posted by mom2mbcb on February 10, 2003, at 10:37:40
Deb,
I agree with the posts by dancingdp and paulk. It's very likely you are one of those "poor metabolizers", and need to reduce your dosage accordingly [see http://www.dr-bob.org/babble/20030119/msgs/137299.html]. This might also explain the problems you've had with other meds. I, too, am very sensitive to most drugs, and have found that my optimal dosage is usually 1/2 (and sometimes as low as 1/10!) the amount that "normal" folks require.
Since Adderall helped but had serious s/e problems, you might want to try good ol' plain dexedrine instead. The l-amphetamine isomers (present in Adderall but not dex) can rub some people the wrong way (myself, for example) and may have been responsible for the high BP. But whatever you do, start with TINY doses. I find that as little as 1 mg/day of dexedrine can be a big help.
Another med you might want to try (in tiny doses, of course) is Ritalin.
BTW, your "usual" BP of 90/60 seems REALLY LOW. What does your pcp think of this?
- Bob
Posted by Dog Breath on February 10, 2003, at 14:53:10
In reply to Re: Straterra, posted by paulk on February 10, 2003, at 8:50:35
It amazes me how people react so differntly to meds. I must be at the far end of the scale. I am on day 19 of Straterra along w/20mg Lexapro and I can't say I have felt anything! I've heard others talk about a "brightening" of mood and increased focus. I'm at 80mg for the last 7 days but It hasn't made any difference. Has anyone else had this reaction? Is 19 days not long enough?
D
Posted by paulk on February 10, 2003, at 17:00:20
In reply to Straterra irritablity, posted by Peter S. on February 10, 2003, at 11:34:29
> I started on Straterra at 10mg for 2 days and went up to 20mg. I've noticed an increase in irritability (also apparent at 10mg) which is extremely unpleasant- although I have had more energy. My mood has been pretty bad and I think worse than before. I really want to stop, but I want to make sure that I'm giving it a fair trial. I'm also taking Lamictal and Neurontin.
>
> I wish there was more data on whether the irritablity goes away in time. I really have difficulty tolerating it. Sounds like some other people are having same effect. Has anyone noticed it going away?
>
> Any psychopharmacologists know why Straterra might cause irritability? Does norepinephrine cause irritability? I was thinking that maybe if it's not balanced out with other neurotransmitters (like serotonin)it might do this. What about combining it with an SSRI? God I hate brain chemistry!
>
Why not go back to 10mg/day - at least until the iritability goes away?
Norepinephrine can do that - you may want to take it with food to limit the peak blood level a bit - smooth things out. I take it you read how for 10% of the population it is 5 times more powerful.This is my first day at 20mg - Seems to be pretty good.
Posted by paulk on February 10, 2003, at 17:04:51
In reply to Straterra-Nothing » paulk, posted by Dog Breath on February 10, 2003, at 14:53:10
As is in the earlier posts - It appears that this drug has a wide range on blood level depending on your genes. You may just need more. I would say if you can't tell you are taking it after 2 - 5 days you probably arn't taking enough. I could tell it was doing something the second day on 10mg. For you, that same blood level could be the same at 50mg.
Posted by Peter S. on February 10, 2003, at 17:38:27
In reply to Re: Straterra, posted by paulk on February 10, 2003, at 17:00:20
paulk- thanks for the advice- I'll probably give the lower dose a try. I'm wondering how often people are taking straterra- once or twice per day?
Thanks!> > I started on Straterra at 10mg for 2 days and went up to 20mg. I've noticed an increase in irritability (also apparent at 10mg) which is extremely unpleasant- although I have had more energy. My mood has been pretty bad and I think worse than before. I really want to stop, but I want to make sure that I'm giving it a fair trial. I'm also taking Lamictal and Neurontin.
> >
> > I wish there was more data on whether the irritablity goes away in time. I really have difficulty tolerating it. Sounds like some other people are having same effect. Has anyone noticed it going away?
> >
> > Any psychopharmacologists know why Straterra might cause irritability? Does norepinephrine cause irritability? I was thinking that maybe if it's not balanced out with other neurotransmitters (like serotonin)it might do this. What about combining it with an SSRI? God I hate brain chemistry!
> >
> Why not go back to 10mg/day - at least until the iritability goes away?
> Norepinephrine can do that - you may want to take it with food to limit the peak blood level a bit - smooth things out. I take it you read how for 10% of the population it is 5 times more powerful.
>
> This is my first day at 20mg - Seems to be pretty good.
>
Posted by ShelliR on February 10, 2003, at 17:41:26
In reply to Straterra-Nothing » paulk, posted by Dog Breath on February 10, 2003, at 14:53:10
well, I've been at 40mg of straterra for a week and feel nothing either. Nothing good; nothing bad. I don't want to go from 40mg to 80mg overnight; I've got to get some of those gel capsules to fill so I can split one 40 into a 20, then proceed with 60mg of straterra next.
Feeling really bad OR feeling nothing have not been good indicators for me in the past. In the hopes that there might be a first time, I'll continue up until at least 80mg for a week. At least it's not making me feel bad.
Shelli
Posted by mom2mbcb on February 11, 2003, at 3:10:38
In reply to Re: Straterra » mom2mbcb, posted by not exactly on February 10, 2003, at 12:43:38
Good thought on Dex, Thanks .
All my docs arent worried about b/p normally being 90/60 as Im only 110 lbs. But it normally in illness has gone to 78/48 and then i got pumped with I.V fluids so the High B/P was more of a concern outta my norm,. I am going to ask the doc about dex. I tried it before but then again I had the Normal dose also.
Deb
Posted by mshyper on February 11, 2003, at 17:07:24
In reply to Re: Straterra, posted by mom2mbcb on February 11, 2003, at 3:10:38
Hi all,
Today is day 14 for me (1st 9 on 18mg-next 5 on 40mg) I take my dose once a day in the morning. Sleepiness finally went away on Sunday (day 12), nausea appears to be gone too. Have been taking with food since experience on Friday and have not had another blood sugar drop. Still have some dizziness, but blood pressure is great! Strattera actually taking care of my anxious stress. Top number dropped 10 and bottom 20. Current # is 140/66. Seem to have clarity most of the day with a couple little daydream sidetrips here and there, but not nearly as bad as before. Will check back in later in the week.
Posted by val on February 16, 2003, at 12:49:09
In reply to Re: Straterra » Cindylou, posted by mom2mbcb on February 8, 2003, at 5:43:19
my son started to take strattera, 18 mg, now on
25 mg. he used to take 54 mg concerta
+ 10 mg ritalin in am.
I haven't noticed the ritalin rebound so much,
but an overall hyperactiveness still, almost like
a regualr kid again. (he is 9rs old) school seems to
be going well, and homework hasn't changed much,
still a bit of a struggle, but am willing to see
if it improves. He is moody, but always is when he
isn't feeling well (flu season). I am hoping that
his ticks will subside, as they seem to be getting
worse with the increase of ritalin. He has been on
strattera for a week now...time will tell. We tried
Adderall, but it made him VERY emotional....
Posted by disney4 on February 17, 2003, at 13:34:06
In reply to Re: Straterra, posted by val on February 16, 2003, at 12:49:09
Could I hear from people who have taken Straterra or Wellbutrin SR for ADHD or ADD? My son has ADHD, and for 19 years we have tried stims-worked well, but caused tics, Desipramine--didn't do enough, and now Wellbutrin SR and Catapress. He hasn't been taking the Catapress recently, and has been on a sub-therapeutic dose of the Well SR. His dose of the Well SR will be increased to the 2 150 tabs, from one a day. I am wondering if it would be better to switch him to Straterra. Does it work better for focus and concentration than the Wellbutrin? My son also has anxiety, and may be smoking pot at times too. We also tried him on Neurontin and Depakote with not much benefit seen.
Posted by essence on February 18, 2003, at 7:05:41
In reply to Re: Straterra or Wellbutrin Sr for ADHD, posted by disney4 on February 17, 2003, at 13:34:06
My son starts Wellbutrin today for ADD - inattentive type,he also has depression and an anxiety disorder, he's 15. It would have been nice to have had some feedback....good luck to you and your son, hope things get resolved.
Posted by SLS on February 18, 2003, at 7:21:17
In reply to I hope you get replies, I didn't when I asked.!!! » disney4, posted by essence on February 18, 2003, at 7:05:41
> My son starts Wellbutrin today for ADD - inattentive type,he also has depression and an anxiety disorder, he's 15. It would have been nice to have had some feedback....
Hi.Don't take it personally.
Perhaps no one here can answer your question for lack of knowledge or experience.
It appears that Strattera is a much better drug for ADD/ADHD than Wellbutrin. You might want to look into adding a psychostimulant to either drug.
- Scott
Posted by Hattree on February 18, 2003, at 9:08:43
In reply to Re: I hope you get replies, I didn't when I asked.!!!, posted by SLS on February 18, 2003, at 7:21:17
Posted by KarenB on February 18, 2003, at 11:58:07
In reply to Re: Straterra approval-Day 5- nmk, posted by BekkaH on January 12, 2003, at 21:19:02
Nicole,
I just read your posts re: Strattera. Are you Bipolar with ADD? (I am) How's it going now? I had read that it was a good alternative for those of us who have ADD without the hyperactivity component.
Let me know how you're doing, OK?
Karen
Posted by disney4 on February 18, 2003, at 14:02:04
In reply to I hope you get replies, I didn't when I asked.!!! » disney4, posted by essence on February 18, 2003, at 7:05:41
Was there a reason the Dr put your son on the Wellbutrin rather than the Straterra? My son has just started taking the correct dosage of Wellbutrin SR. He is also taking Catapress for anxiety and tics, although he often forgets to take it. I have to make sure he takes the Catapress at night, because I fear for an irregular heartbeat if taken too close to the Wellbutrin. I give him the first dose of Wellbutrin in the AM and the second 6 hours later.
Posted by Essence on February 18, 2003, at 15:20:52
In reply to Re: I hope you get replies, I didn't when I asked.!!! » essence, posted by disney4 on February 18, 2003, at 14:02:04
Hi Disney;
Straterra and Adderall are not available here in Canada where I live. My sons psychiatrist felt that since he has no hyperactivity with his ADD (He's ADD-inattentive) and is suffering from depression and anxiety that Wellbutrin would be the better choice of med for him. (He suggested either the Wellbutrin or Celexa). He will take his meds at 7 am and again at 2 pm. He will be titrating up and it will be 3 weeks before he's on the maximum dosage that is being prescribed. He was due to start his meds today but asked if we could put it off till Friday. I agreed, I think he's nervous about starting it and doesn't want to start it and go to school the same day. He has a long weekend coming up. My concern is that it may exacerbate his anxiety. Anyhow, good luck to you and your son, keep posting, I'd like to hear how things are going.
Ess
Posted by Essence on February 18, 2003, at 15:24:19
In reply to Re: I hope you get replies, I didn't when I asked.!!!, posted by SLS on February 18, 2003, at 7:21:17
Thnx Scott;
Any experience with Wellbutrin, whether for ADD or depression alone would have been helpfull. Straterra, as well as Adderall, isn't available in Canada yet.
Ess
Posted by bennett on February 18, 2003, at 15:43:03
In reply to Re: Straterra or Wellbutrin Sr for ADHD, posted by disney4 on February 17, 2003, at 13:34:06
My experience has been that Wellbutrin didn't do much for focus and a tremor that I developed from stimulents continued with it. It was great for depression and addictive cravings though.
Strattera gives me all the + benefits I experienced with stimulents and my tremor has decreased considerably.
I did have noticeable side effects (dizziness, major sedation primarily) for the first two weeks, and need to take it with food.
I had pretty much stopped smoking under the Wellbutrin and I notice I am beginning to smoke again - the cravings for cigs are back. I haven't noticed much rebound effect at all on the strattera. Been on it for about 3 weeks now.
all in all - I am very happy with the strattera thus far.
good luck
bennett
Posted by disney4 on February 18, 2003, at 15:56:13
In reply to Re: Straterra or Wellbutrin Sr for ADHD, posted by bennett on February 18, 2003, at 15:43:03
Thanks for the info. I think my son needs to give the Straterra a try. I don't think the Wellbutrin has done much for his ADHD so far. Do you know if Catapress works well with Straterra? What was your starting dosage of Straterra, and how quickly did you get to the therapeutic dose?
Posted by SLS on February 18, 2003, at 16:16:33
In reply to Re: Straterra or Wellbutrin Sr for ADHD » disney4, posted by Essence on February 18, 2003, at 15:20:52
> Straterra and Adderall are not available here in Canada where I live.Have you ever tried desipramine (Norpramin)? It might make a good substitute for Strattera. Like Strattera, desipramine is a selective and potent norepinephrine (NE) uptake inhibitor. Wellbutrin is known to make tics worse.
- Scott
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