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Dr. Bob is Robert Hsiung, MD,
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Posted by noa on February 2, 2003, at 13:32:14
In reply to Re: is strattera the same thing as reboxetine??, posted by cybercafe on February 1, 2003, at 17:30:49
I don't think it is the same as reboxetine, but my pdoc said it is related. It is atamoxetine.
Posted by not exactly on February 2, 2003, at 13:34:49
In reply to Re: Started Strattera Yesterday Woo-Hoo! » HADD Enough, posted by SLynn on February 2, 2003, at 12:35:18
How recently did your son discontinue stimulant medication? The tiredness may be due to stimulant withdrawal rather than a Strattera s/e.
- Bob
Posted by not exactly on February 2, 2003, at 14:26:13
In reply to Re: is strattera the same thing as reboxetine??, posted by noa on February 2, 2003, at 13:32:14
> I don't think it is the same as reboxetine, but my pdoc said it is related. It is atamoxetine.
They are different, but in the same "family" ( pharmacologically and chemically). They are both selective norepinephrine reuptake inhibitors. The atomoxetine (Strattera) molecule [see http://pi.lilly.com/us/strattera-pi.pdf] is a hybrid of reboxetine [http://biopsychiatry.com/reboxetine] and fluoxetine [http://biopsychiatry.com/fluoxetine], which makes sense when you consider that Strattera's manufacturer (Lilly) also makes fluoxetine (better known as Prozac).
Atomoxetine is only available in the US (so far) as the brand name Strattera, and is approved/marketed only for treating ADHD (even though it has antidepressant qualities). Reboxetine, on the other hand, is available in Europe (as Edronax), but not the US, and is approved/marketed for treating depression (although it would probably also help with ADHD). Apparently, Lilly fought hard to prevent reboxetine from gaining FDA approval (in order to protect its antidepressant sales), then chose to market its own variant in the US as an ADHD med instead, hoping to create market share as the only ADHD drug which is not a "controlled substance" (Schedule II).
People who have tried both atomoxetine and reboxetine claim that they noticed some minor differences in action and side effects. Interestingly enough, many believe that atomoxetine is a more effective antidepressant than reboxetine!
hope this helps
- Bob
Posted by Phil on February 2, 2003, at 16:25:35
In reply to Re: is strattera the same thing as reboxetine??, posted by not exactly on February 2, 2003, at 14:26:13
I should hope so, Reboxetine was a big flop with, I think, everyone on this site who tried it.
Posted by cybercafe on February 2, 2003, at 16:34:06
In reply to Re: is strattera the same thing as reboxetine?? » not exactly, posted by Phil on February 2, 2003, at 16:25:35
> I should hope so, Reboxetine was a big flop with, I think, everyone on this site who tried it.
a flop just for depression, or ADD as well?
i'm in canada, and i think we have reboxetine but not strattera :(
Posted by Phil on February 2, 2003, at 17:03:11
In reply to Re: is strattera the same thing as reboxetine??, posted by cybercafe on February 2, 2003, at 16:34:06
I honestly don't remember anyone staying on it for any condition. If the search starts working, you can see all the excitement the drug generated but it just didn't work very well.
I've heard more positive posts on Straterra already than I ever saw vith Rebox.
Posted by HADD Enough on February 2, 2003, at 17:50:53
In reply to Re: Started Strattera Yesterday Woo-Hoo! » HADD Enough, posted by not exactly on February 2, 2003, at 12:07:59
Hi Bob,
Thanks for your encouragement and observations.
> Hmmm... Those don't sound like ADD symptoms to me. If you had said that your marriage was in trouble because your wife felt you didn't listen to her and you weren't acting like a responsible adult, then the ADD diagnosis would make more sense. But maybe there's something else going on.
Actually, it was not really clear from the way I described the issues, but you pretty much clarified it. Yes, I don't/couldn't focus enough to listen to her, and I've not been acting as a responsible adult for most of my adult life. And I have also been unable to control my moving from one topic to another, my drifting off in the middle of a conversation, my intolerance of frustration, and my inappropriate anger when I do get frustrated. And, I don't mean to do any of these things...I just can't control them. Heck, I probably fit all the parameters for ADD in the DSM-IV :-)
> You say you're not depressed. But depression takes many forms. Just because you don't feel sad and hopeless every day doesn't mean that all forms of depression can be ruled out. You may have a touch of atypical or bipolar depression.This is always a possibility. I never had a "major depressive event", but I did have panic attacks in high school and, for all I know, I may have a touch of GAD as well.
> BTW, I'm no doctor, and I apologize if my conjectures are making you uncomfortable. I'm just thinking out loud, and mostly trying to be supportive.
Not to worry...I always appreciate a new opinion...it's good to have feedback from outside myself and it helps me to look at things in a different light than I might have otherwise.
> How long has it been since you took Ritalin or Concerta? If you discontinued a stimulant recently, that can produce "spacey" feelings for a while.
I stopped the stims months ago. I've been unmedicated for that time and I'm probably the worse for it.
> Another possibility is that it's an "adjustment" phenomenon. Strattera may have changed your perceptions of reality just enough to make the world seem a bit "unfamiliar". If so, this feeling will disappear once you get used to it.
Could be...hope so.
> Again, congratulations on discovering the "magic bullet" so quickly. This sort of success usually takes a lot more trial & error.
Thanks again...I'm trying to keep my euphoria in check...two days is a REALLY short time to evaluate an NSRI, or any new drug for that matter, but SOMETHING is happening and I am hopeful that I may have found an answer for me. I'll update periodically.
Cheers,
Bill
Posted by HADD Enough on February 2, 2003, at 17:54:36
In reply to Re: Started Strattera Yesterday To: not enough, posted by HADD Enough on February 2, 2003, at 17:50:53
Posted by HADD Enough on February 2, 2003, at 18:02:19
In reply to Re: Started Strattera Yesterday Woo-Hoo! » HADD Enough, posted by SLynn on February 2, 2003, at 12:35:18
> Hello...
>
> I am so glad that the Strattera is working for you! I am thrilled so far with this new ADD medication myself.
>
> My son (he is 9) started it yesterday. He weighs 65 pounds and they started him on 18 mg...he is to take it for 4 days then increase to 25mg. He was pretty tired all day, but he was not near as "figity". He seemed pretty alert, but the tiredness really got to him. However, he had "tics" on the stimulants and they are now stopping! I am so relieved. Also, he did not get sick...which from what I have read, is a sign of an allergic reaction. They say that the Strattera takes time, so if you are feeling this much better already, just think how you will feel after the next 7 days or so. Also, the "spaciness" that you are feeling seems to be pretty normal the first few days (from everything that I have read...my son is doing the same thing). How did you sleep while on the Strattera compared to the stimulants? My son fell asleep on the floor at 8:30 last night and I had to get him up at 9:45 this morning. I could not believe it! Usually, I cannot get him to go to sleep or sleep peacefully all night. He had the best sleep last night than he has had in years! Please keep us all posted on your progress...this medication is so new that is nice to read about what others are going through. I am so glad to get my son off of stimulants (he has been on them for 3 years)...they have really messed him up. I am praying this new drug will work for everyone out there who is sensitive to the stimulant medications. Congratulations and keep us informed!!!
>
> SLynn
>Thanks for your kind words. I am really happy for you and your son and I hope he continues to do well!
I fell asleep easily last night at about midnight, but I woke up at around 5 AM...early for me, but I didn't feel as though I didn't get enough sleep. I'll see how this goes as I progress.
Cheers,
Bill
Posted by SLynn on February 2, 2003, at 20:30:55
In reply to Re: Started Strattera Yesterday Woo-Hoo! » SLynn, posted by not exactly on February 2, 2003, at 13:34:49
> How recently did your son discontinue stimulant medication? The tiredness may be due to stimulant withdrawal rather than a Strattera s/e.
>
> - Bob
>
Hi Bob...He just went off of the stimulant yesterday, so I know that the tiredness is due to the stimulant withdrawal. So far so good with Strattera side effects...have not seen any!
SLynn
Posted by dancingdp on February 5, 2003, at 18:48:24
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
Is this site working now? TEST
Posted by fairnymph on February 5, 2003, at 22:15:10
In reply to Re: is strattera the same thing as reboxetine?? » not exactly, posted by Phil on February 2, 2003, at 16:25:35
I found reboxetine very effective for depression, stimulating, and free of side effects. It didn't help with my anxiety/OCD, but it was a fantastic med otherwise, one of the best I've tried (and I've tried half a dozen).
> I should hope so, Reboxetine was a big flop with, I think, everyone on this site who tried it.
Posted by Cindylou on February 7, 2003, at 7:13:57
In reply to Re: Started Strattera Yesterday Woo-Hoo! » not exactly, posted by SLynn on February 2, 2003, at 20:30:55
I posted earlier about severe sedation I experienced my first day on Straterra (I took 25 mg.) The sedation set in about 5 hours after taking it. My pdoc wants me to try it at night, but I haven't tried it since that first day.
I'm very curious to know if anyone else has experienced this effect, and/or has any insights or suggestions. I greatly appreciate any responses!
Thanks,
Cindy
Posted by dancingdp on February 7, 2003, at 9:27:03
In reply to Anybody else sedated on Straterra? Please respond, posted by Cindylou on February 7, 2003, at 7:13:57
> I posted earlier about severe sedation I experienced my first day on Straterra (I took 25 mg.) The sedation set in about 5 hours after taking it. My pdoc wants me to try it at night, but I haven't tried it since that first day.
>
> I'm very curious to know if anyone else has experienced this effect, and/or has any insights or suggestions. I greatly appreciate any responses!
>
> Thanks,
> CindyHi Cindy,
My son who is 10 is on Strattera and has not been tired at all. My suggestion to you go to lower the dose and work your way up gradually. I have a lot of experience with meds and it sound like you started off on too high a dose. You must be sensitive to meds anyway. My suggestion is that you start with 18 mg. I can't believe these doctors that are not more cautious about meds especially a NEW one like strattera. Please TELL your dictor that you would like to lower the dose and slowly work your way up after 4 days on 18 mg. You have to be your own doctor sometimes because doctors so not have all the answers. Good luck and let me know how it goes.
dancin
Posted by mshyper on February 7, 2003, at 10:32:31
In reply to Re: Anybody else sedated on Straterra? Please respond, posted by dancingdp on February 7, 2003, at 9:27:05
My doc started me on 18mg nine days ago. No sedation until day 6, ended day 8, other assorted side effects, none severe, all passed away pretty quickly.
Today is day 10, first day on 40 mg. Boy what a trip. I've had rolling symptoms, overly sensitive fingertips (I type) crawly feelings. It triggered a hypoglycemic episode this morning. All happened in the first 1.5 hours after I took the 40mg. I think it's just from the increase. Will see if it's better tomorrow morning. I also have to mention that I was taking the 18mg with breakfast, and this morning I took it almost half an hour before I got to eat. This could have been the problem. Won't take the med again unless I'm eating with it!
Otherwise, it's helping the major disorganization, focus, frustration problems greatly. I can actually sit down at night when I get home from work and read entire chapters in a book. It used to be one sentence and I was distracted already. By the way, I am a 39-yr old adult female.
Good luck with your course of dosage.
Posted by sjb on February 7, 2003, at 11:49:16
In reply to Anybody else sedated on Straterra? Please respond, posted by Cindylou on February 7, 2003, at 7:13:57
I certainly did and stopped it after 6 days. Still oversleeping and overeating. Does anyone know what that half life is?
Posted by not exactly on February 7, 2003, at 13:00:44
In reply to Re: Anybody else sedated on Straterra? Please respond, posted by sjb on February 7, 2003, at 11:49:16
> Does anyone know what that half life is?
short answer: typically 5 hours, but can be as much as 24 hours
long answer, from the official "prescribing information" document:
Human Pharmacokinetics
Atomoxetine is well-absorbed after oral administration and is minimally affected by food. It is eliminated primarily by oxidative metabolism through the cytochrome P450 2D6 (CYP2D6) enzymatic pathway and subsequent glucuronidation. Atomoxetine has a half-life of about 5 hours. 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 in 10-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)]. Drugs that inhibit CYP2D6, such as fluoxetine, paroxetine, and quinidine, cause similar increases in exposure.[the complete document can be downloaded from http://pi.lilly.com/us/strattera-pi.pdf]
- Bob
Posted by Cindylou on February 7, 2003, at 13:05:04
In reply to Re: Anybody else sedated on Straterra? Please respond, posted by dancingdp on February 7, 2003, at 9:27:03
Thanks everyone for your responses! Dancin, thanks for the suggestion of taking a lower dose. My pdoc is hard to get into, and hard to get in touch with (I am looking for a new one, obviously!) I wonder if, in the meantime, I could just open up the capsule and dump out half?
Thanks again,
cindy
Posted by Cindylou on February 7, 2003, at 13:09:43
In reply to Re: Anybody else sedated on Straterra? Please respond, posted by Cindylou on February 7, 2003, at 13:05:04
I just got an answer on another thread about dumping out the capsule. (Sounds like it's worth a try!)
Thanks again to everyone.
cindy> Thanks everyone for your responses! Dancin, thanks for the suggestion of taking a lower dose. My pdoc is hard to get into, and hard to get in touch with (I am looking for a new one, obviously!) I wonder if, in the meantime, I could just open up the capsule and dump out half?
>
> Thanks again,
> cindy
Posted by HADD Enough on February 7, 2003, at 15:02:44
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
I'm now at 60mg/day and still doing great! The side effects I've had so far (upset stomach, constipation) are minor and disappear after a couple of days. They came back for a little bit when I upped the dosage from 40 to 60mg, but I suspect that they will diminsh in time. I saw my pdoc yesterday and told him how much better my concentration, focus and mood have been and discussed my major concern...namely that the drug's effectiveness will diminish over time. He indicated to me that from the clinical trials, and from anecdotal evidence he has heard from his colleagues that the drug's action tended to get better over time (6 months) rather than diminsh. All I know is that, for me, this continues to be a miracle drug!
I'm working with my pdoc to tweak the dosage until I get maximum benefits at minimum dosage. He told me that Lilly has modified their max dosage recommendations from 100mg/day for adults to 80 mg/day. My pdoc said that I could remain at 60mg/day or try to go to 80 when I feel ready. I'm going to stay at 60 for a couple of weeks, and then try 80. If there is no marked difference, I'll probably go back to 60 and settle there, but if 80 is better then I'll stay at 80.
I'll update again in a week or earlier if there is anything else major to report.
Cheers,
HADD Enough
Posted by bennett on February 7, 2003, at 15:30:55
In reply to Re: Anybody else sedated on Straterra? Please resp » dancingdp, posted by mshyper on February 7, 2003, at 10:32:31
Sedation? Oh yes. Only with food? Oh yes!
2nd day - 5 hours after taking 18 mg – middle of the afternoon, I had to lay down – two hours later I woke up still tired
I’ve experienced this off and on since then – and it doesn’t seem to be related to lack of sleep.
High side of this is that I’m weaning myself off of Ambien because I don’t seem to need as much as I used to to get to sleep – and I’m hoping I can get by with out it. By 11-11:30 I’m pretty tired and ready for bed – that’s very unusual for me. 2-3 AM has been my normal “bed time” ever since I had a choice in such things.
Dizziness (if I smoke a cigarette) and sedation are the two side effects I’ve experienced the most so far.
The stimulants I’ve taken in the past had a similar sedative effect. Ritalin and Dexedrine calmed me down so much, I would sometime fall asleep in the afternoon. But by night time I was on a roll and had to knock myself out to get to sleep.But I’m very happy to say that the strattera finally started to help with focus and ADD sx.
I nursed the dose from 18 mg/day, to 18am/18pm with no positive effects. It wasn’t until I took 2 -18 mg caps on the morning of the 8th day that I noted some very positive effects. And on day 9, when I moved both AM and PM doses to 36 mg (I only have 18 mg caps) I began to see results very similar to when I used to take stimulants.
I had to get off Dexedrine about two years ago and went on wellbutrin.
The welbutrin helped in a sideways kind of way by stabilizing my mood so I was able to be quiet enough to attend better but it didn’t help the focus at all. I had to leave my job as a result of this shift in medication – I’d moved into administrative duties that my un-medicated ADD self was entirely unsuited for.I’m on day 12 now, and very pleased with the Rx as far as some ADD sx are concerned. I’ve started finishing old projects (the kind that require reading lists and numbers that I'm not particluarly interested in - but that I really need to get done) that have been sitting around forever.
Yesterday, I found myself going through my running 2 year old to-do list updating it to the present. Without Rx. I cannot get myself to look back at the undone items in a list without getting sidetracked and not getting back to what I was in the middle of when I started.
However, if I were still working in the office I used to work in, the side effects I’ve experienced so far probably would have precluded my staying with it.For instance, this morning I took the dose 1/2 hour before breakfast and an hour later was so nauseous and dizzy that I had to lie down. I spent the next hour and a half on the couch trying to stay centered and quiet till it passed.
Then, as suddenly as the nausea and dizziness came on –it was gone – and I felt fine. I opened my eyes, got up and started working. Fortunately I was at home during all of this.
I won’t take this without food again.
Well, that’s my story so far.My sweetie is coming to visit this weekend and I’ll get to see if the socially interactive sx. have improved. I still talk a lot, but I seem not to interrupt as much. In any event, she’ll let me know since she has seen them at their worst (and their best) over the years.
We’ll be at a festival with lots of people and booths screaming for my attention. If I find I can keep a conversation going with her while we’re walking along – without stopping mid-sentence to talk to someone else or getting totally distracted by something I see … ...
She’ll let me know how this stuff is working….
By the way I'm a 61 yr old male diagnosed ADD in 1992.
thanks,
bennett
Posted by harper on February 7, 2003, at 18:30:16
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
My 13 year old daughter has been on 40 mg for the last month. The ADD is much better and she's had no side affects except for sleepiness and an upset stomach the first couple of days. The only problem now is her terrible and increasing moodiness.
Even though I think puberty has something to do with the moodiness, I think she needs an antidepressant along with the Strattera.What antidepressants are others taking with this med? Since this is a new med, her doctor doesn't have any experience with this one (even though he is a big shot at NIMH in child psychiatry!), I want to give him suggestions.
I understand some people are on Wellbutrin with this med. How much and how is it working?
Please respond.
Posted by ShelliR on February 7, 2003, at 19:31:32
In reply to Straterra , posted by harper on February 7, 2003, at 18:30:16
Posted by Cindylou on February 7, 2003, at 21:06:10
In reply to Straterra , posted by harper on February 7, 2003, at 18:30:16
Hi Harper,
I noticed in an earlier post that a teenager on Strattera also had increased moodiness ... it's so hard to tell with all those hormones raging what is causing what.I am taking Lexapro, and so far it is the only antidepressant I've been able to tolerate. My pdoc said the combo of Lexapro and Strattera is fine. (As for my experience, I have only taken Strattera for one day. I was extremely sedated and haven't had the guts to try it again. I am quite confident that the sedation didn't have anything to do with the combo of the meds, however, since I am very med-sensitive and I react strongly to medications across the board.)
Lexapro is an SSRI, like Prozac, but has much fewer side effects. It's quite new, so the drawback is that it's not as "tried and true" as Prozac.
Best of luck to you and your daughter. I had a tough time when I was 13 ... my heart goes out to her and to you!
cindy.
> My 13 year old daughter has been on 40 mg for the last month. The ADD is much better and she's had no side affects except for sleepiness and an upset stomach the first couple of days. The only problem now is her terrible and increasing moodiness.
>
> Even though I think puberty has something to do with the moodiness, I think she needs an antidepressant along with the Strattera.What antidepressants are others taking with this med? Since this is a new med, her doctor doesn't have any experience with this one (even though he is a big shot at NIMH in child psychiatry!), I want to give him suggestions.
> I understand some people are on Wellbutrin with this med. How much and how is it working?
> Please respond.
Posted by mom2mbcb on February 8, 2003, at 5:43:19
In reply to Re: Straterra » harper, posted by Cindylou on February 7, 2003, at 21:06:10
day 3 of straterra, I noticed slight ( very slight ability to focus , wasnt sure it was working , this was day 2 on 18 mg straterra on feb 6 , feb 7 i felt much beter in the a.m but by evening I felt wound up again..to a much higher degree than i thought i was prior to strattera, I read the drug doesnt cause rebound, would a higher dose make it last longer, seemed to last from about 6 am to about 2 am ...I dont want to be a roller coaster. what do you think. My adhd doc wants me to stay at 18 mg for a month..i thought titration was every 3 day to a week...
Deb
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