Posted by 10derHeart on June 21, 2008, at 22:18:47
In reply to Strattera - nausea will it go away?, posted by TexasChic on June 20, 2008, at 22:21:43
Hi TC,
I have been on Strattera (80 mgs/day) for 4.5 years. See the threads linked from this one (but warning, they may bore you to tears as I drone on and on...):
http://www.dr-bob.org/babble/20080606/msgs/834180.html
Never had the nausea, but had severe dry mouth and some annoying headaches - all gone within a week or two, as best I can recall.I did want to post a caution, which may not be needed as I'm hoping your doc discussed this with you already. I had also been taking Prozac daily (only 20mg) when pdoc and I decided to try Strattera. There is a documented interaction between atomoxetine and fluoxetine (Prozac), as well as Paxil, [not sure what mechanism of action there is with the Wellbutrin???] that my pdoc was cautious about when I first started. In layman's terms, I think it's correct to say having Prozac on board can significantly increase the action of the atomoxetine because there's more concentrated in the blood, so it's all about care with adjusting the dose, not so much contraindication. But if I've described this incorrectly * please* one of you brilliant folks here correct me!
So in 2004, my pdoc had me taper down to (I think) 20mgs Prozac 2x a week before he'd go past 40mg/day. with Strattera. Now in my case, I was having near complete remission from depression at the time, though, and the man focus was a non-stim ADD medication. The plan was to get rid of the Prozac, hoping Strattera would treat primarily ADD symptoms, but if it helped with any low-level depression as well, fine. It turned out to work very well just that way. Possibly, the depression continued to be kept at bay due to the huge help w/ADD stuff from the Strat, which in turn meant I felt so much less lost and overwhelmed in the psycho-social realm, I didn't become depressed. For me, I always felt after much research and talking with other sufferers, that the undiagnosed, untreated ADD likely led to the depression.
See the package/prescribing cautions:
>>CYP2D6 Activity and Atomoxetine Plasma Concentration<<
Atomoxetine is primarily metabolized by the CYP2D6 pathway to 4-hydroxyatomoxetine. In EMs, inhibitors of CYP2D6 increase atomoxetine steady-state plasma concentrations to exposures similar to those observed in PMs. Dosage adjustment of atomoxetine HCl in EMs may be necessary when coadministered with CYP2D6 inhibitors, e.g., paroxetine, fluoxetine, and quinidine (see DRUG INTERACTIONS). In vitro studies suggest that coadministration of cytochrome P450 inhibitors to PMs will not increase the plasma concentrations of atomoxetine.
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"In children and adolescents over 70 kg body weight and adults administered strong CYP2D6 inhibitors, e.g., paroxetine, fluoxetine, quinidine, atomoxetine HCl should be initiated at 40 mg/day and only increased to the usual target dose of 80 mg/day if symptoms fail to improve after 4 weeks and the initial dose is well tolerated."
--------------------------------------------I have hypertension as well, as was on a beta blocker at the time, and still am, at twice the dose it was in 2004, with no problems. (I know Lisinopril is an ACE inhibitor - I tried it once - cough, cough, cough - day and night = discontinue) I'd watch the BP a little closer than usual, though, as Strattera has been known to elevate BP readings very slightly in some people. But as we all know, YMMV.
I so hope this helps you, TC....I am one of the blessed ones who had an immediate response, which I know is rare. Hope you can give it at least 4 weeks, barring intolerable S/Es and I think it's great your doc is willing to try it.
poster:10derHeart
thread:835733
URL: http://www.dr-bob.org/babble/20080617/msgs/835870.html