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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by fallsfall on April 8, 2004, at 9:15:21
I've been on Strattera for over a year. I take 80mg in the morning (along with a bunch of other meds). Last summer I had an intolerable sweating problem (I would sweat just sitting in a chair), so now that I'm feeling a little more stable depression-wise I want to see if I can drop the Strattera (which is the most likely culprit for the sweating).
I didn't find much in the archives about stopping Strattera. My pdoc said to go from 80mg to 40mg for a week, then every 4 - 7 days decrease from 40 to 25 to 18 to 10mg. I remember that going up SLOWLY was really important on Strattera - what about going down? I guess I'm nervous about cutting it in half right off the bat. Any experiences?
Thanks!
Falls.
Posted by fallsfall on April 8, 2004, at 9:16:41
In reply to Strattera Withdrawal, posted by fallsfall on April 8, 2004, at 9:15:21
I did see in the archives that you had stopped Strattera. Any advice for me?
Thanks so much.
Posted by jrbecker on April 8, 2004, at 16:55:42
In reply to Re: Reba, Narnett, MilaS?, posted by fallsfall on April 8, 2004, at 9:16:41
from Manisses's Psychopharmacology Alert...
Atomoxetine can be discontinued abruptly
Discontinuing atomoxetine (Strattera) will not result in symptom rebound or other adverse events, even without tapering, according to research published in the February issue of the Journal of Clinical Psychopharmacology.
Some drugs that affect neurotransmitter release can bring about changes in neuroregulation when taken regularly over periods of time. When discontinued after chronic use, the patient may experience adverse effects or withdrawal symptoms in addition to a recurrence of symptoms of the illness.
Atomoxetine, approved for the treatment of attention-deficit/hyperactivity disorder (ADHD), acts as a blocker for the presynaptic norepinephrine transporter. Those who take it for ADHD treatment usually do so on a regular regimen for extended periods. Researchers looked at two identical studies that involved a total of 194 children with ADHD to assess atomoxetine’s potential for this type of discontinuation syndrome.
The children, ages 7 to 12, were assessed after 9 to 10 weeks of continuous atomoxetine treatment. The studies included a two week evaluation/washout period followed by approximately 9 weeks of double-blind treatment with either atomoxetine titrated to a maximum dose of 2.0 mg/kg/d administered twice daily, or placebo.
At completion of acute treatment, patients entered a single blind, one-week discontinuation phase. Patients who had received atomoxetine during the treatment phase of the study received placebo during this week.
At the end of the week, patients were seen and evaluated for ADHD symptoms using the Attention Deficit Hyperactivity Disorder Rating Scale-IV-Parent Version (ADHD RS). Adverse events were assessed by open-ended questioning and the Barkley Behavior and Adverse Events Questionnaire – Modified. Other safety evaluations included vital signs and laboratory measures. The researchers found no statistically significant differences for any adverse events between the children abruptly discontinuing from atomoxetine and those continuing on placebo treatment.
While the symptoms of ADHD gradually worsened following drug discontinuation, they did not return to pretreatment levels. The incidence of discontinuation-emergent adverse events was low and there were no statistically significant differences between the patients abruptly discontinuing from atomoxetine and those continuing on placebo.
A significant difference (P = 0.05) was found in "difficulty staying asleep." The atomoxetine discontinuation group showed some improvement, as compared to the placebo group who had a slight worsening.
The results of these studies suggest that treatment with atomoxetine can be stopped without concern that patients will experience unpleasant or otherwise problematic symptoms, say the researchers. The rate of symptoms return for most patients is likely to be gradual and not associated with symptom rebound or overshoot beyond the initial baseline severity.
Wernicke JF, Adler L, Spencer T, et al.: Changes in Symptoms and Adverse Events After Discontinuation of Atomoxetine in Children and Adults With Attention Deficit/Hyperactivity Disorder: A Prospective, Placebo-Controlled Assessment. Journal of Clinical Psychopharmacology 2004; 24:30-35. Correspondence to: Joachim Wernicke, M.D., Ph.D., Lilly Corporate Center DC 6337, Indianapolis, IN 46285; e-mail: jwernicke@lilly.com.
http://www.manisses.com/2online/PUAlert/ARCHIVES/2004/PA03-18.html
Posted by fallsfall on April 9, 2004, at 9:34:40
In reply to Atomoxetine can be discontinued abruptly, posted by jrbecker on April 8, 2004, at 16:55:42
Thanks, jrbecker. That helps put my mind at ease.
Plus I assume that since no one else responded either no one else is discontinuing Strattera, or the withdrawal must be a non-issue. So I will proceed with my doctor's plan and try to remember to post a followup.
Posted by zenclearer on April 9, 2004, at 20:57:43
In reply to Atomoxetine can be discontinued abruptly, posted by jrbecker on April 8, 2004, at 16:55:42
Interesting study, insofar as it mentions the problems of discontinuation with "Some drugs that affect neurotransmitter release can bring about changes in neuroregulation when taken regularly over periods of time. When discontinued after chronic use, the patient may experience adverse effects or withdrawal symptoms in addition to a recurrence of symptoms of the illness."
Of course, those "some drugs" are amphetamines.
> from Manisses's Psychopharmacology Alert...
>
> Atomoxetine can be discontinued abruptly
>
> Discontinuing atomoxetine (Strattera) will not result in symptom rebound or other adverse events, even without tapering, according to research published in the February issue of the Journal of Clinical Psychopharmacology.
>
> Some drugs that affect neurotransmitter release can bring about changes in neuroregulation when taken regularly over periods of time. When discontinued after chronic use, the patient may experience adverse effects or withdrawal symptoms in addition to a recurrence of symptoms of the illness.
>
> Atomoxetine, approved for the treatment of attention-deficit/hyperactivity disorder (ADHD), acts as a blocker for the presynaptic norepinephrine transporter. Those who take it for ADHD treatment usually do so on a regular regimen for extended periods. Researchers looked at two identical studies that involved a total of 194 children with ADHD to assess atomoxetine’s potential for this type of discontinuation syndrome.
>
> The children, ages 7 to 12, were assessed after 9 to 10 weeks of continuous atomoxetine treatment. The studies included a two week evaluation/washout period followed by approximately 9 weeks of double-blind treatment with either atomoxetine titrated to a maximum dose of 2.0 mg/kg/d administered twice daily, or placebo.
>
> At completion of acute treatment, patients entered a single blind, one-week discontinuation phase. Patients who had received atomoxetine during the treatment phase of the study received placebo during this week.
>
> At the end of the week, patients were seen and evaluated for ADHD symptoms using the Attention Deficit Hyperactivity Disorder Rating Scale-IV-Parent Version (ADHD RS). Adverse events were assessed by open-ended questioning and the Barkley Behavior and Adverse Events Questionnaire – Modified. Other safety evaluations included vital signs and laboratory measures. The researchers found no statistically significant differences for any adverse events between the children abruptly discontinuing from atomoxetine and those continuing on placebo treatment.
>
> While the symptoms of ADHD gradually worsened following drug discontinuation, they did not return to pretreatment levels. The incidence of discontinuation-emergent adverse events was low and there were no statistically significant differences between the patients abruptly discontinuing from atomoxetine and those continuing on placebo.
>
> A significant difference (P = 0.05) was found in "difficulty staying asleep." The atomoxetine discontinuation group showed some improvement, as compared to the placebo group who had a slight worsening.
>
> The results of these studies suggest that treatment with atomoxetine can be stopped without concern that patients will experience unpleasant or otherwise problematic symptoms, say the researchers. The rate of symptoms return for most patients is likely to be gradual and not associated with symptom rebound or overshoot beyond the initial baseline severity.
>
> Wernicke JF, Adler L, Spencer T, et al.: Changes in Symptoms and Adverse Events After Discontinuation of Atomoxetine in Children and Adults With Attention Deficit/Hyperactivity Disorder: A Prospective, Placebo-Controlled Assessment. Journal of Clinical Psychopharmacology 2004; 24:30-35. Correspondence to: Joachim Wernicke, M.D., Ph.D., Lilly Corporate Center DC 6337, Indianapolis, IN 46285; e-mail: jwernicke@lilly.com.
>
>
> http://www.manisses.com/2online/PUAlert/ARCHIVES/2004/PA03-18.html
>
Posted by fallsfall on April 10, 2004, at 8:48:16
In reply to Re: Atomoxetine can be discontinued abruptly » jrbecker, posted by zenclearer on April 9, 2004, at 20:57:43
This is my 3rd day on 40 mg (after being on 80 mg for over a year). Yesterday I almost fainted at work. I needed to restrict myself to sitting (I work in a library, shelving books was definately out). This morning I am feeling distant and foggy. I didn't want to wake up (more than usual).
I'm sure that this is side effects of withdrawal (I had lightheadedness when I went on Strattera, too). I'm trying to decide between reducing more gradually (i.e. taking around 60mg for a couple of days) or just toughing this out and getting it over with. I don't have a lot of commitments in the next two days, so I'm leaning towards toughing it out.
I'd love to hear about other people's experiences!
Posted by fallsfall on April 11, 2004, at 9:25:57
In reply to Re: Strattera withdrawal - light headed, posted by fallsfall on April 10, 2004, at 8:48:16
Yesterday was a little better. Still a bit foggy and sleepy, but I could walk short distances and actually did some work on my taxes.
Looks like I took both my evening meds and this morning's meds last night. Sigh, just what I need - more variation in the dose my body sees.
This is the end of the thread.
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