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Dr. Bob is Robert Hsiung, MD,
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Posted by val on February 16, 2003, at 12:49:09
In reply to Re: Straterra » Cindylou, posted by mom2mbcb on February 8, 2003, at 5:43:19
my son started to take strattera, 18 mg, now on
25 mg. he used to take 54 mg concerta
+ 10 mg ritalin in am.
I haven't noticed the ritalin rebound so much,
but an overall hyperactiveness still, almost like
a regualr kid again. (he is 9rs old) school seems to
be going well, and homework hasn't changed much,
still a bit of a struggle, but am willing to see
if it improves. He is moody, but always is when he
isn't feeling well (flu season). I am hoping that
his ticks will subside, as they seem to be getting
worse with the increase of ritalin. He has been on
strattera for a week now...time will tell. We tried
Adderall, but it made him VERY emotional....
Posted by disney4 on February 17, 2003, at 13:34:06
In reply to Re: Straterra, posted by val on February 16, 2003, at 12:49:09
Could I hear from people who have taken Straterra or Wellbutrin SR for ADHD or ADD? My son has ADHD, and for 19 years we have tried stims-worked well, but caused tics, Desipramine--didn't do enough, and now Wellbutrin SR and Catapress. He hasn't been taking the Catapress recently, and has been on a sub-therapeutic dose of the Well SR. His dose of the Well SR will be increased to the 2 150 tabs, from one a day. I am wondering if it would be better to switch him to Straterra. Does it work better for focus and concentration than the Wellbutrin? My son also has anxiety, and may be smoking pot at times too. We also tried him on Neurontin and Depakote with not much benefit seen.
Posted by essence on February 18, 2003, at 7:05:41
In reply to Re: Straterra or Wellbutrin Sr for ADHD, posted by disney4 on February 17, 2003, at 13:34:06
My son starts Wellbutrin today for ADD - inattentive type,he also has depression and an anxiety disorder, he's 15. It would have been nice to have had some feedback....good luck to you and your son, hope things get resolved.
Posted by SLS on February 18, 2003, at 7:21:17
In reply to I hope you get replies, I didn't when I asked.!!! » disney4, posted by essence on February 18, 2003, at 7:05:41
> My son starts Wellbutrin today for ADD - inattentive type,he also has depression and an anxiety disorder, he's 15. It would have been nice to have had some feedback....
Hi.Don't take it personally.
Perhaps no one here can answer your question for lack of knowledge or experience.
It appears that Strattera is a much better drug for ADD/ADHD than Wellbutrin. You might want to look into adding a psychostimulant to either drug.
- Scott
Posted by Hattree on February 18, 2003, at 9:08:43
In reply to Re: I hope you get replies, I didn't when I asked.!!!, posted by SLS on February 18, 2003, at 7:21:17
Posted by KarenB on February 18, 2003, at 11:58:07
In reply to Re: Straterra approval-Day 5- nmk, posted by BekkaH on January 12, 2003, at 21:19:02
Nicole,
I just read your posts re: Strattera. Are you Bipolar with ADD? (I am) How's it going now? I had read that it was a good alternative for those of us who have ADD without the hyperactivity component.
Let me know how you're doing, OK?
Karen
Posted by disney4 on February 18, 2003, at 14:02:04
In reply to I hope you get replies, I didn't when I asked.!!! » disney4, posted by essence on February 18, 2003, at 7:05:41
Was there a reason the Dr put your son on the Wellbutrin rather than the Straterra? My son has just started taking the correct dosage of Wellbutrin SR. He is also taking Catapress for anxiety and tics, although he often forgets to take it. I have to make sure he takes the Catapress at night, because I fear for an irregular heartbeat if taken too close to the Wellbutrin. I give him the first dose of Wellbutrin in the AM and the second 6 hours later.
Posted by Essence on February 18, 2003, at 15:20:52
In reply to Re: I hope you get replies, I didn't when I asked.!!! » essence, posted by disney4 on February 18, 2003, at 14:02:04
Hi Disney;
Straterra and Adderall are not available here in Canada where I live. My sons psychiatrist felt that since he has no hyperactivity with his ADD (He's ADD-inattentive) and is suffering from depression and anxiety that Wellbutrin would be the better choice of med for him. (He suggested either the Wellbutrin or Celexa). He will take his meds at 7 am and again at 2 pm. He will be titrating up and it will be 3 weeks before he's on the maximum dosage that is being prescribed. He was due to start his meds today but asked if we could put it off till Friday. I agreed, I think he's nervous about starting it and doesn't want to start it and go to school the same day. He has a long weekend coming up. My concern is that it may exacerbate his anxiety. Anyhow, good luck to you and your son, keep posting, I'd like to hear how things are going.
Ess
Posted by Essence on February 18, 2003, at 15:24:19
In reply to Re: I hope you get replies, I didn't when I asked.!!!, posted by SLS on February 18, 2003, at 7:21:17
Thnx Scott;
Any experience with Wellbutrin, whether for ADD or depression alone would have been helpfull. Straterra, as well as Adderall, isn't available in Canada yet.
Ess
Posted by bennett on February 18, 2003, at 15:43:03
In reply to Re: Straterra or Wellbutrin Sr for ADHD, posted by disney4 on February 17, 2003, at 13:34:06
My experience has been that Wellbutrin didn't do much for focus and a tremor that I developed from stimulents continued with it. It was great for depression and addictive cravings though.
Strattera gives me all the + benefits I experienced with stimulents and my tremor has decreased considerably.
I did have noticeable side effects (dizziness, major sedation primarily) for the first two weeks, and need to take it with food.
I had pretty much stopped smoking under the Wellbutrin and I notice I am beginning to smoke again - the cravings for cigs are back. I haven't noticed much rebound effect at all on the strattera. Been on it for about 3 weeks now.
all in all - I am very happy with the strattera thus far.
good luck
bennett
Posted by disney4 on February 18, 2003, at 15:56:13
In reply to Re: Straterra or Wellbutrin Sr for ADHD, posted by bennett on February 18, 2003, at 15:43:03
Thanks for the info. I think my son needs to give the Straterra a try. I don't think the Wellbutrin has done much for his ADHD so far. Do you know if Catapress works well with Straterra? What was your starting dosage of Straterra, and how quickly did you get to the therapeutic dose?
Posted by SLS on February 18, 2003, at 16:16:33
In reply to Re: Straterra or Wellbutrin Sr for ADHD » disney4, posted by Essence on February 18, 2003, at 15:20:52
> Straterra and Adderall are not available here in Canada where I live.Have you ever tried desipramine (Norpramin)? It might make a good substitute for Strattera. Like Strattera, desipramine is a selective and potent norepinephrine (NE) uptake inhibitor. Wellbutrin is known to make tics worse.
- Scott
Posted by essence on February 18, 2003, at 18:27:08
In reply to Re: Straterra or Wellbutrin Sr for ADHD » Essence, posted by SLS on February 18, 2003, at 16:16:33
Scott, does Wellbutrin cause tics or just exacerbate tics? Thnx
Ess
Posted by SLS on February 18, 2003, at 21:30:49
In reply to Re: Straterra or Wellbutrin Sr for ADHD » SLS, posted by essence on February 18, 2003, at 18:27:08
> Scott, does Wellbutrin cause tics or just exacerbate tics? Thnx
> EssHi Ess.
I read that Wellbutrin (bupropion) both produced and exacerbated tics.
- Scott
--------------------------------------------------------
"Bupropion was effective in its few controlled trials, but tics and (especially in youth) skin rash limit its value."http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9418743&dopt=Abstract
--------------------------------------------------------" We present four cases of children with ADHD and comorbid TS treated with bupropion in whom tics were exacerbated by this medicine. This series suggests that bupropion may not be an appropriate alternative to stimulants in the treatment of ADHD in TS."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8428875&dopt=Abstract
--------------------------------------------------------
Posted by bennett on February 18, 2003, at 23:44:10
In reply to Re: Straterra or Wellbutrin Sr for ADHD » bennett, posted by disney4 on February 18, 2003, at 15:56:13
I don't know if my dosage history will help, given I'm older than your son but I posted the dosage increases in an earlier post at:
http://www.dr-bob.org/babble/20030204/msgs/140009.html
basically I started at 18 for 3 days and worked my slowly up to 72 (36 and 36) over a 2 week period - I didn't feel much + effect until then.
hope this helps
bennett
Posted by JohnnyB on February 25, 2003, at 20:32:26
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
I started reading messages at the beginning of this thread, 12/28/02, and haven't managed to wade through them all yet, so if any points or questions in this message are addressed in previous postings, please post a reply with links. I will catch up.
I am a 47 y/o male, 6', 180#. I am my doc's first patient on Strattera, her "guinea pig". For ADHD, Inattentive, she started me
on 40 mg. x 1 per day, increasing to 40 mg. x 2 per day after seven days, as per the medical newsletter she subscribes to.
On night one, I slept 3 hrs. On night two, I slept 2 hrs. On night three,
I slept 3 - 4 hrs. Last night I slept around 4 hrs. Each of these nights,
I fell asleep O.K., but then woke right around 2:00 A.M. Eli Lilly says
some adults in the clinical trials had insomnia and it went away. They said
to start with a lower dose. The pharmacist says to cut back to a lower dose.
My doc left town for two weeks, but another doc in her practice says cut
back and will write another script.I'm trying to get a sense of what sorts of start-up regimens different
adults are using. I am finding some talk of dosages on some message boards,
but was wondering how your doc started you on it. From the message boards,
it seems like many adults are starting 18 mg. x 1 for a week, then 18 x 2
for a week, then .......I'd like to report to you other effects, but being this sleep deprived, I
can't really tell about mood, focus, etc. It's all pretty bad right now.
I'm a little short tempered, but otherwise feeling stretched quite thin.
One other side effect hit yesterday and was pretty bizarre. My testicles
started aching like I was wearing pants that were way too tight. I didn't
take another 40 mg. this morning and the testicle thing has passed by now.
About two hours after taking a 40 mg. pill, the inside of my chest feels
tense and I can feel my carotid pulse without palpating with my fingers.
Pulse rate is good and blood pressure is only slightly higher than normal. While the drug was at it's peak effect (I guess), my eyes were taking longer then normal to focus when looking up at distant objects after focussing close in for awhile. That could be from a lack of sleep. No dry eyes, mouth, etc. and I live in arid Colorado. Peeing seems normal.
Since starting this message, I got a script called in and picked up 18 mg. caps to last for 14 days @ 1/day , then the docs says I'll go up to 40 mg. again, if all is well. I'll wait till tomorrow A.M. to take the first 18 mg. Maybe I can sleep past 2:00 A.M. this time.I'm thinking I am a poor metabolizer, which I take to mean that I don't get
rid of the drug as fast as good metabolizers, therefore needing less of it
for the same effect. ??????????It's been helpful to read all these postings.
Thanks,
John
Posted by mshyper on February 26, 2003, at 0:02:24
In reply to Re: Straterra approval., posted by JohnnyB on February 25, 2003, at 20:32:26
My doc bumped me up to 40 after 9 days on 18. I nearly came out of my skin at 40. Plus, I had few side effects at 18, but really nasty ones at 40. My doc took me back down to 18. On Thursday, he is supposed to make it 18 morning and 18 evening. The 18 was plenty to give me the focus and everything until about 4:30 in the afternoon, hence the possible addition of the second pill. Hope yours balances out soon!
Posted by JohnnyB on February 26, 2003, at 9:15:46
In reply to Re: Straterra approval., posted by JohnnyB on February 25, 2003, at 20:32:26
For backround details, see http://www.dr-bob.org/babble/20030224/msgs/203834.html
Night 5: After 3.5 hrs. of sleep, I woke at 2:30 A.M. and couldn't get back to sleep the rest of the night. I took no Straterra yesterday and took the an 18 mg. this morning around 6:30. No other meds at all.
With this sleep deprivation, I still can't tell about the benefits of this med. Still none of the typical SE's I've seen mentioned here with the exception of some erectile difficulties, but that could easily be attributed to lack of sleep. I just want more sleep and it's hard to be patient and give this med a chance.
If just one person out there could tell me they had this degree of sleep difficulty and it went away while staying on Straterra, that would be reassuring. Anyone?
Posted by JohnnyB on February 26, 2003, at 9:55:29
In reply to Re: Straterra and sleep experiences?, posted by JohnnyB on February 26, 2003, at 9:15:46
I've seen a fair number of posts mentioning opening and dividing up Strattera capsules. I was going to get gel caps and split my 40 mg. caps. When I asked my pharmacist, she was wary of the idea and called Eli Lilly for me. They said the contents of the capsules are caustic with direct contact with skin. Of course they stand to profit from me having to buy 18 mgs. but then it could also really be caustic too. Comments?
Posted by Hattree on February 26, 2003, at 9:56:58
In reply to Re: Straterra approval., posted by JohnnyB on February 25, 2003, at 20:32:26
Sounds like too high a dose to me. I'd go slower. This is a wild guess, but I think we inattentive types might need less. Certainly can't hurt to drop it down...maybe you should take a day or two off and get some sleep, then restart.
I started and after a couple of days stopped, because I was feeling depressed...I'm hoping it wasn't the Strattera. I had an intense weekend and thought I was better off with old dex.
Posted by Hattree on February 26, 2003, at 10:01:14
In reply to Don't split Strattera caps according to Lilly, posted by JohnnyB on February 26, 2003, at 9:55:29
I split 'em and haven't noticed a problem. I've been pouring about a quarter in a shot glass, mixing it and drinking it, but then I'm pretty tolerant about bad tastes of that nature. It's too haphazard, though. I'm thinking of springing for smaller caps.
Posted by paulk on February 26, 2003, at 10:45:27
In reply to Don't split Strattera caps according to Lilly, posted by JohnnyB on February 26, 2003, at 9:55:29
Total spin - I've had it all over my hands. They just want your money.
I split the 25mg to get 12.5 mg. Taste is bad - you can split them to empty capsuls.
Posted by not exactly on February 26, 2003, at 14:10:19
In reply to Don't split Atomoxetine (Straterra)caps according » JohnnyB, posted by paulk on February 26, 2003, at 10:45:27
You're not going to get an honest and unbiased opinion from the manufacturer, because they have nothing to lose and everything to gain by advising against splitting the caps. Not only do they "want your money", they also want to keep their money. If they told you that splitting a cap was OK, thereby "officially condoning the practice", then they could be liable for a lawsuit in the event that something bad happened as a result (even if causation could not be proven).
As a general rule of thumb, information should not be regarded as absolute truth without considering the source of said information, and what they stand to gain or lose by telling the truth. [If I hinted that this principle should be applied to religion & politics as well, Dr. Bob would redirect this post to Psycho-Babble Faith or Psycho-Social-Babble. :-) ]
BTW, as a chemist (with nothing to gain or lose by this claim) I can assure you that neither atomoxetine nor any of the fillers in a Strattera capsule would be harmful in contact with normal skin. It's possible that some people might be allergic or hypersensitive to the capsule contents, but they will have a more negative reaction to ingesting the caps than they would to opening them.
I stand by the comments I made on this subject in a previous posting [http://www.dr-bob.org/babble/20030125/msgs/137561.html].
- Bob
Posted by viridis on February 26, 2003, at 14:27:37
In reply to Re: Don't split Strattera caps according to Lilly, posted by not exactly on February 26, 2003, at 14:10:19
I've mentioned this here before, but will repeat my experience with Wellbutrin SR. The literature says don't divide them, and people seem to think that this is because they have a slow-release coating. But when I called GSK and spoke with one of the people who actually developed the slow-release form, he said that splitting the pills was fine, and they'd even tested this quite extensively. The slow release is controlled by the wax matrix inside, which dissolves at the same rate whether split or not. When I asked why they discourage people from splitting them, he said it's just because it's hard to get accurate dosing (the pills aren't scored so don't split exactly evenly). Also, if they sit around split for days, they take up moisture from the air. But the product info makes it sound like splitting the pills will cause dire consequences. It certainly didn't for me.
I have no idea whether this applies to Strattera (which I realize is a capsule), but it's a case in point with many potential parallels.
Posted by viridis on February 26, 2003, at 14:41:07
In reply to Re: Don't split Strattera caps according to Lilly, posted by not exactly on February 26, 2003, at 14:10:19
This "caustic ingredients" thing is interesting. Years ago, when I took Prozac, I found the 20 mg pills (the only size available at the time) too strong. I asked my doctor if I could divide the contents into two capsules; he checked with the rep (I think this was Lilly too?) and she said no, the contents are too caustic.
Interesting...of course, they do have to cover themselves. I'm a biologist, and have containers of sodium chloride (table salt) and sucrose (common sugar) in my lab. They each warn that in case of contact with skin, one should flush with water for 15 minutes and call a doctor if any reaction occurs. I wonder if it's a similar CYA situation with pharmaceuticals?
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