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Re: hypersensitivity, depression - not exactly BekkaH

Posted by not exactly on January 25, 2003, at 22:32:08

In reply to Re: hypersensitivity, depression - not exactly, posted by BekkaH on January 25, 2003, at 16:24:28

> Hello "not exactly":
>
> In your post, you suggested that the previous poster open a capsule of Strattera and take a fraction of the capsule's contents. According to the Strattera website, the capsule should not be broken or sprinkled on food. You said you are a chemist, so perhaps you know more about this than I do, but I thought it was significant that Lilly specifically advised against opening the capsule. There are some drugs in capsule form that can be broken, but apparently this is not one of them.
>
> Bekka


Bekka,

Thank you for pointing this out. I hadn't seen this warning.

Yes, I'm a chemist, and the study of neurochemistry/psychopharmacology is my hobby (some might call it an obsession). But I'm not omniscient. :-)

I had looked over the Strattera website fairly thoroughly, and carefully read the entire "prescribing info" .pdf document at least twice (as I mentioned, I hope to try Strattera soon, so I've been researching it extensively). But somehow I missed the warning about opening a capsule. A quick Google search with the query "sprinkled site:strattera.com" indeed turned up the following statement: "Strattera capsules should never be broken and sprinkled on food. They must be taken whole." This appears on the "How to Take Strattera" page [http://www.strattera.com/cnt_taking/howtotake.html] and is repeated verbatim on the FAQ page [http://www.strattera.com/cnt_common/faqs.html#5].

Frankly, I am surprised and puzzled by this statement. Such warnings are typical for medications that are time-release, enteric, or incompatible with food. However, none of these apply to the Strattera capsules in particular or their contents (atomoxetine) in general. The two other prescription medications that are in the same chemical family, namely reboxetine [http://biopsychiatry.com/reboxetine/index.html] and fluoxetine (Prozac) [http://biopsychiatry.com/fluoxetine/index.html], do not have this warning.

But most significantly, there is no mention of this anywhere in Lilly's official "prescribing information". This is the thorough and definitive source of information on the product for doctors, pharmacists, and patients, most of whom will never see the website. Such prescribing information documents (also called "product inserts" or "monographs") are carefully prepared by pharmaceutical manufacturers, and rigorously scrutinized by their medical, chemical, and legal experts before publishing to minimize the possibility of any negative effects (including scandals and lawsuits) of using their products. If opening a capsule were truly inadvisable, then surely the warning would appear here. Unless specifically counterindicated, many people would try this, not to subdivide a dose, but because they have difficulty with swallowing capsules.

My theory, and I stress that it is _only_ a theory, is that whoever prepared the text for that portion of the website copied the boilerplate information from some other medication, edited it to say "Strattera", and neglected to delete the part that didn't apply. Such "cut-and-paste" errors are not uncommon on the internet.

In another Strattera thread [http://www.dr-bob.org/babble/20030119/msgs/136572.html], "britwit" refers to taking doses of "12.5 mg" and "37.5 mg", which are certainly not standard sizes. I'm assuming this was done by splitting the 25 mg caps. So we know at least one person on this board is opening capsules, perhaps (hopefully) according to a doctor's recommendation.

In summary:
1) I still believe it is safe and reasonable to open a Strattera capsule and take a portion of the contents - I personally would not hesitate to do so
2) the warning which appears on the website (but _not_ in the prescribing information) is most likely an error
3) again, I AM NOT A DOCTOR - consult the medical professional who prescribed Strattera for you before you attempt any dosing regimen which differs from what they indicated

- Bob


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poster:not exactly thread:133458
URL: http://www.dr-bob.org/babble/20030125/msgs/137561.html