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Re: Straterra AND Ritalin-UPDATE

Posted by Mike Oxsbig on July 28, 2003, at 11:25:55

In reply to Re: Straterra AND Ritalin-UPDATE, posted by manyparts2001 on July 24, 2003, at 4:15:42

While admittedly sponsored by Eli Lilly, the makers of Strattera, Floyd Sallee, MD and Ph. D. (Professor of Psychiatry and Pediatrics) at Cincinnati Children's Medical spoke of his experience as part of the drug trials for Strattera. He made the following points that I found helpful:

1. While Strattera has a half-life of about 5.2 hours, and targets primarily norepinephrine, the drug indirectly impacts dopamine action that continues beyond the time the drug is in the system. Thus one a day dosing is all that is necessary in most cases.

2. Dosing levels are very conservative if one follows the FDA dosing guidelines. The FDA does not suggest above 100 mg/ day. That may not be high enough for patients who weigh more. A 1.4-1.6 mg/kg/day formula may be a more realistic target dosage. Dosages up to 200 mg/day may not be unreasonable. Dr. Salle does not feel that there are any significant risk even with overdosage.

3. The only 2 psychotropic drugs to worry about taking with Strattera are Prozac and Paxil (Well, and the MAO inhibotors which are extremely rarely used). Use smaller doses when using along side them.

4. There is no problem using Strattera along side the psychostimulants such as Ritalin, Concerta, Metadate or Adderall.

5. Strattera appears to carry over to the next morning, impacting in a positive manner.

6. Strattera is rapidly absorbed, with maximal plasma levels reached in 1-2 hours after dosing.

7. Strattera has been found to be helpful with tic disorders comorbid with ADHD. Does not exacerbate tics or Tourette's Syndrome.

8. Regarding how long before it makes an impact is fairly rapid, a conservative approach should be to wait two weeks once one has reached a normal optimal dosage before increasing again.

9. A starting dosage of about .5 mg/kg/day should be increased to target dosage after about 3-4 days. This helps minimize the impact of side effects if started with a full dosage.

10. Strattera does not appear to potentiate the impact of alcohol.

11. While chemically different than Prozac, it may be helpful to think of it as a cousin of Prozac in terms of the way it works. However, its action is very specific to norepinephrine. It also appears to target most specifically the prefrontal cortex of the brain, which is the main brain center implicated in executive function and ADHD problems.

12. There are some reports of sexual dysfunction side effects in adult use. > I contact Eli Lilly yesterday for their input about the combination of the two and was told they did not have any studies or feedback on the safety or combining of thetwo. All they had was their own research, which is really limited from what I understand. It was just long enough to get approval; however, they are continuing the study and really appreciated my feedback. Plus, they did not have any studies on long term use of Straterra. What she did say was that Ritalin worked on a diffeent neurotransmitter in the brain than did Straterra. But, this was all of the information she had.
> So, I said all of that to say again how much I appreciate everyone's feedback. Manyparts




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