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Dr. Bob is Robert Hsiung, MD,
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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
Posted by CC67 on July 29, 2003, at 0:13:45
In reply to Re: strattera and ritalin » CC67, posted by blondegirl47 on July 28, 2003, at 8:36:39
Blondegirl hi,I take "calcium carbonate/600mg+D 200I.U."----At same time I take the "250mg magnesium Oxide" "osco brand"same as "albertsons"
Sorry about taking so long to get back to you.
take care!! CC67.
Posted by blondegirl47 on July 29, 2003, at 8:17:16
In reply to Re: strattera and ritalin, posted by CC67 on July 29, 2003, at 0:13:45
No Problemo cc67, thanks for the info. :)
Blondegirl
Posted by reba on July 29, 2003, at 20:05:36
In reply to Re: strattera and ritalin, posted by reba on July 29, 2003, at 19:34:14
Hello all
I have been taking Strattera since February. Revently my doc and i decided that it might not be the best drug for me. Ive never tried any stims before so we decided to try adderal. We decided that the best option would be to go off the strattera at the same time I start the Adderol, becuase I am leaving to go back to school in 4 weeks. (Im a college student) The probelm is I feel horrible! the combo of going off the strattera and on the adderol has made me feel TERRIBLE so I wanted to know if anyone knows about the side effects of going off strattera because I cant find info about it anywhere!! PLEASE let me know if you have any feed back on what is normal while going off strattera, and also what is normal going off adderol! thanks!
Posted by teacherkris on July 29, 2003, at 21:44:27
In reply to Re: strattera and ritalin » CC67, posted by blondegirl47 on July 29, 2003, at 8:17:16
Hi all,
Well I haven't posted for awhile so here's the latest update. I'm still on 80 mg. I went back to takign it twice a day for awhile to try to alleviate the afternoon tiredness. It helped but I got sick of having to remember so I just recently went back to once a day and the tiredness is gone. I've been on Strattera since February. The road to here was definitely rocky but worthwhile.
One of the main reasons I wanted to go on Strattera was to be able to take Excederin and Sudafed again since those two don't mix well with stimulants. Amazingly I haven't been sick since going on it until now. So Sunday was the big test. When taking Sudafed with Concerta/Ritalin I felt like I was losing my mind and was on massive amounts of speed. I have nothing like that now with Strattera. I feel maybe a little more spacey than normal but nothing major. I'm so thrilled to be able to take it again! Just thought I'd let you all know!
Posted by fallsfall on July 29, 2003, at 22:19:45
In reply to strattera WITHDRAWL?, posted by reba on July 29, 2003, at 20:05:36
I could be wrong, but I thought that it was OK to just stop the Strattera. There is a Strattera website (http://www.strattera.com/index.jsp) that will have all the details. I can't give you personal information because I'm still taking my Strattera.
Good Luck
Posted by reba on July 29, 2003, at 23:42:53
In reply to Re: Strattera day 3- Coffee w/ meds » Viridis, posted by AJY on July 27, 2003, at 5:36:22
Just wondering if anyone else has noticed anything similar to hot flashes while on strattera? I havent read of anyone else feeling like that but i will break out in cold sweats many times a day for no reason other than doing simple think like cleaning my room. I feel like im not doing much moving at all and i get over heated soooo easily. Anyone else?
Posted by Viridis on July 30, 2003, at 1:07:10
In reply to strattera WITHDRAWL?, posted by reba on July 29, 2003, at 20:05:36
Strattera is a pretty new drug, and typically evidence of withdrawal from these meds takes a while to filter down and become common knowledge. I just assume that nearly all of them will induce withdrawal after extended use, because they change your brain chemistry (that's the point) and it takes a while for the brain to get accustomed to doing without them.
I have no experience with Strattera withdrawal (I'm still working up on the dose) but the standard way to come off these meds is to gradually reduce the amount you take rather than stopping suddenly.
BTW, I take Strattera together with Adderall and find the combination beneficial. I doubt there would be any harm in reducing Strattera while introducing Adderall, and there's no evidence that I'm aware of that contraindicates taking both at the same time.
Posted by fallsfall on July 30, 2003, at 10:30:52
In reply to Side effects, posted by reba on July 29, 2003, at 23:42:53
I sweat like crazy. If it is over 80 degrees I sweat while sitting still. This deprives my dogs of their daily walk. If I do anything at all I have to take a shower.
My doctor prescribed Hytrin and it has helped the sweating some. Now I can move if I'm willing to get sweaty - it used to be impossible to move at all.
So Strattera gives me the motivation to move, but takes it away because I'm too sweaty. Go figure.
Posted by manyparts2001 on July 30, 2003, at 13:34:03
In reply to Re: strattera WITHDRAWL? » reba, posted by Viridis on July 30, 2003, at 1:07:10
I break into the most awful sweats right after I take a shower, and usually have to stand in front of a fan on full speed to cool down. Then, I get dressed and do my hair, which is a total waste of time because within 15 minutes I am sweating profusely again. I have to keep it so cold in her that my grandaughter has to wear sock and shoes to help her stay warm-we used to go barefoot. My husband was wondering if it could be any meds I was on, and I am going to mention this to my doctor on Saturday. I was pleased to hear that there is actually yet another med that would ease the sweating, and I am going to ask about that as well. Thanks for posting your concern, as I had the same but for some reason just didn't post it.
Posted by Lasagne on July 30, 2003, at 14:54:34
In reply to strattera WITHDRAWL?, posted by reba on July 29, 2003, at 20:05:36
******REPLY TO BELOW POST***********
Hi:
I don't have specific experience with going off of Strattera, but I have had the problem with Prozac which works on serotonin instead of norephinephrine (like Strattera). When I tried to taper off of the Prozac I felt nausea and headache. It also affected my digestive system. You may have to do a tapering off system with the Strattera while you are beginning your Adderall treatment. I felt the withdrawl symptoms even more when I tried to go directly from 60 mgs. of Prozac to 40 mgs. My doctor then suggested that I do 60 mgs. on Sunday,Tuesday, Thursday, Saturday and then 40 mgs. on Monday, Wednesday, Friday. Then eventually make it so I took 60 mgs. three times a week and 40 mgs. of the rest of the days until I was able to feel comfortable on the 40mgs. alone. I have heard of people having withdrawl symptoms from Paxil too. It is quite uncomfortable going through these types of withdrawls. My son actually takes the Strattera with his Adderall and the combination works better than the Strattera alone. Something to think about. I also take Strattera but thus far I have gotten really good results and don't anticipate going off of it anytime soon.
Lasagna> Hello all
> I have been taking Strattera since February. Revently my doc and i decided that it might not be the best drug for me. Ive never tried any stims before so we decided to try adderal. We decided that the best option would be to go off the strattera at the same time I start the Adderol, becuase I am leaving to go back to school in 4 weeks. (Im a college student) The probelm is I feel horrible! the combo of going off the strattera and on the adderol has made me feel TERRIBLE so I wanted to know if anyone knows about the side effects of going off strattera because I cant find info about it anywhere!! PLEASE let me know if you have any feed back on what is normal while going off strattera, and also what is normal going off adderol! thanks!
>
>
Posted by Lasagne on July 30, 2003, at 14:59:57
In reply to Side effects, posted by reba on July 29, 2003, at 23:42:53
> Just wondering if anyone else has noticed anything similar to hot flashes while on strattera? I havent read of anyone else feeling like that but i will break out in cold sweats many times a day for no reason other than doing simple think like cleaning my room. I feel like im not doing much moving at all and i get over heated soooo easily. Anyone else?
*******REPLY TO ABOVE POST*******
Yes, when I first began Strattera I had the hot flashes and excessive sweating and I am not even close to menapause. Around week 5 or 6 that side effect diminished and I am feeling just fine now. It's obnoxious to deal with, but hang in there and see if this problem improves.
Lasagna
Posted by reba on July 30, 2003, at 17:22:16
In reply to Re: Side effects » reba, posted by Lasagne on July 30, 2003, at 14:59:57
Thanks!! it is nice to hear that im not the ONLY one having gross sweating/hot flash problem! Just to let others know that I have been on Strattera since the begining of February and they have not gone away, but im glad to hear some people tapper off of this! I am actually going off strattera now so i wont have to deal with this anymore!!!
Posted by reba on July 30, 2003, at 17:34:27
In reply to Re: strattera WITHDRAWL? » reba, posted by Lasagne on July 30, 2003, at 14:54:34
Ok I was the original one to ask about the withdrawal, so i though I would come back and say more about it to help those who have problems with it in the future.
Ok, so I looked for ever on the internet about people experiencing strattera withdrawal symptoms and found NOTHING except on the lily website about strattera stating that there was no withdrawal effect.. haha THANKS! so I have been doing a little reasearch on other anti-depressant withdrawal symptoms becuase this is the first kind of med i have taken for anything. My symptoms seem to be alot like other anti-depressant withdrawal symptoms. I did do a little tappereing off; I was originally taking 80mlg, and for a week a went to 40, then after o week on 40 I stopped. I had flu like symptoms such as feeling very tired for no reason, feeling very achy, including very sore muscles, also had bad head aches on and off. I also went through periods of mood swings, like crying over nothing, and having a very short fuse. I aslo seemed to be very sensative to light and sounds. I wasnt hungry and was naushous alot. For me these didnt last that long but long enough... I have been off strattera now for 3 days, and today wok eup feeling a little better. so since messing with my dose ive felt yucky about a week and a half, which isnt so long consedering some of the other things i have read about other anti-depressants! lol. I feel lucky that it is summer and I can allow myself to just lay down and do nothing.. Some of the other things I felt were not being able to wake up for a couple hours after getting out of bed, and also my head feels very weird, almost like i get dizzy, but more like i have soup sloshing around in my head. haha Just very spacy in a bad way i guess. Hopefully this will help some of you! Oh and i was on Strattera for 6 months before going off it. good luck to everyone and thanks for responding!
Posted by fallsfall on July 30, 2003, at 22:23:19
In reply to Re: strattera WITHDRAWL?, posted by reba on July 30, 2003, at 17:34:27
Thanks for the summary! Some time in my life I'll go off it, too.
Posted by Trena on August 1, 2003, at 6:19:12
In reply to Re: Straterra approval-Day 5- nmk, posted by BekkaH on January 12, 2003, at 21:19:02
have a question for neone willing to answer. my son is on the adderol xr and experiences very bad emotional outburst with this medication. would like to try the strattera but as he is only 4 i don't know if it would work for him. just to give you some history. he is severe adhd with mild autism. he is very aggresive and hyper without medication but the adderol i feel makes him more aggresive but less hyper.would like to find a comfortable medium. please help. thanks
Posted by reba on August 1, 2003, at 7:34:05
In reply to Re: Straterra approval-Day 5- nmk, posted by Trena on August 1, 2003, at 6:19:12
TRINA:
I found this book "Healing ADD, the breakthrough program that allows you to see and heal the 6 types of add" by Daniel G. Amen, M.D. to be sooooooooo helpful, and it sounds like you could benafit from reading parts if not all of the book. It really backs up the theory that there are 6 diff types of ADD all with certain characteristics, needing somewhat different types of meds to help. It was such a great book and i remember reading just last night about one of the 6 types, and probems that usually arise, just like yours! i strongly recommend this book, i think it just gives such a great insight on ADD and it actually explains the theories and gives good eplanations on why different meds help the different type. It talks about brain chemestry and stuff. I have ready many books on ADD and i just found this one to be by far is the most helpful, and i think more people with different ADD issues can really relate to the theories. Goodluck hope this maybe helps you and others out, cause i swear this is an awsome book!>OLD MESSAGE>>> have a question for neone willing to answer. my son is on the adderol xr and experiences very bad emotional outburst with this medication. would like to try the strattera but as he is only 4 i don't know if it would work for him. just to give you some history. he is severe adhd with mild autism. he is very aggresive and hyper without medication but the adderol i feel makes him more aggresive but less hyper.would like to find a comfortable medium. please help. thanks
>
Posted by Trena on August 1, 2003, at 8:57:28
In reply to Re: Straterra approval-Day 5- nmk, posted by reba on August 1, 2003, at 7:34:05
thanks i will go to the book store this weekend.i want so much to understand what he is going through and ways to help him deal with it so that he can have a normal life.
Posted by blondegirl47 on August 1, 2003, at 10:18:52
In reply to Re: Straterra approval-Day 5- nmk, posted by Trena on August 1, 2003, at 6:19:12
Some find that if adderall doesn't work, then the drugs like ritalin are better. Focalin and concerta are a form of ritalin. Some Dr's are using Strattera and a stimulant together.
Good luck!
Blondegirl
Posted by Lasagne on August 1, 2003, at 12:42:55
In reply to Re: Straterra approval-Day 5- nmk, posted by Trena on August 1, 2003, at 6:19:12
*********REPLY TO BELOW POST***********
Hi:
My son is almost 11 and he has severe ADHD with a mood component and sensory defensiveness (aka Sensory Integration Dysfunction,something that is also common amongst autistic children.) Anyway when we first went to our doctor with our son's difficulties he first started him on Celexa, an anti-depressant. This initially improved his mood dramatically and then there was a tapering off. That is when we began stimulant treatment. The combination gave him good control through most of the day and then in the late afternoon and early evening he would start having meltdowns/emotional outbursts sometimes combined with aggressive behavior. The doctor says this is something that is common as the stimulant meds (even the slow/time release versions) wear off at the end of the day. So that is when he began our son on Clondine. It is a blood pressure med that is used in very small doses to help calm these emotional outbursts down. My son is usually asleep within an hour of taking it and we don't hear again from him till the morning. He gets a good nights rest and has a better handle on himself because of it. His insomnia was causing a behavioral vicious cycle. Recently we also tried the Strattera. At first it had good results and then it tapered off at which point we had to combine the Strattera with stimulant treatment. Overall,it has had good results on his behavior. The Strattera makes him more tolerable to handle in the morning until his stimulant med kicks in. Because of your son's age I am not sure if the FDA will allow your doctor to prescribe the Strattera. If your doctor says he will give you a prescription for it, then I definitely think it is worth a try. If his outbursts seem to be mostly in the evening I would I also consider asking if your doctor will let you give your son Clonidine. If your son's outbursts are sporatic during the day and evening then you might want to consider an antidepressant or Strattera(if permitted) in combination with the Adderall XR. I hope this isn't too confusing. It is very difficult keeping these children stabilized. It seems like we are in to see our doctor every single month. All together my son takes the following meds:
Celexa 30 mgs. daily
Strattera 50 mgs. daily
Adderall XR 60 mgs. daily
Clonidine .03 mgs. daily
Also, another thing that I have noticed with my two oldest sons (that have ADHD) is that the Adderall seems to cause a more emotional response as it wears off than the time release ritalin formulas. Yet the Adderall seems to give the best control during it's effective hours. These things just aren't easy. I too have a 4 year old son that my doctor wants to wait to treat until he is in school.> have a question for neone willing to answer. my son is on the adderol xr and experiences very bad emotional outburst with this medication. would like to try the strattera but as he is only 4 i don't know if it would work for him. just to give you some history. he is severe adhd with mild autism. he is very aggresive and hyper without medication but the adderol i feel makes him more aggresive but less hyper.would like to find a comfortable medium. please help. thanks
>
Posted by Dr. Bob on August 1, 2003, at 17:28:23
In reply to Re: Straterra approval-Day 5- nmk, posted by reba on August 1, 2003, at 7:34:05
> I found this book "Healing ADD, the breakthrough program that allows you to see and heal the 6 types of add" by Daniel G. Amen, M.D. to be sooooooooo helpful
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though, and doesn't *have* to be used. If people *choose* not to use it, I'd be interested why not, but I'd like that redirected to Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by james_schmidt on August 2, 2003, at 8:35:11
In reply to Re: Help! It has been weeks on Straterra!, posted by dancingdp on March 6, 2003, at 8:47:45
I have been on strat for a few months and the drug has helped tremendously. The higher dose put me into a confused and mild depressed state 40mg 1 x day. What I have found is that original treatment on the eli's site was trials at twice a day. I switched to 25mg 2x day and I feel great it has helped me tremendously. You should notice a difference with your child within a few weeks. If you do not then maybe the drug is the wrong choice.
Good luck.
Posted by Shel Swartz on August 2, 2003, at 15:54:08
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
This product, like most others, was created by a chemical company hoping to make enough profits than the cost of lawsuits. Takng chemicals for ADHD (another disease made up by money-hungry pyschiatrists) is DANGEROUS. What you are feeling is a placebo effect. PERIOD!
If the supposed doctors are sio learned, how come they get just as sick as everyone else, and die off just as we do?
The motivation: MONEY.
Posted by Lasagne on August 2, 2003, at 17:47:42
In reply to Re: Straterra approval., posted by Shel Swartz on August 2, 2003, at 15:54:08
> This product, like most others, was created by a chemical company hoping to make enough profits than the cost of lawsuits. Takng chemicals for ADHD (another disease made up by money-hungry pyschiatrists) is DANGEROUS. What you are feeling is a placebo effect. PERIOD!
>
> If the supposed doctors are sio learned, how come they get just as sick as everyone else, and die off just as we do?
>
> The motivation: MONEY.
Yes, I agree that companies are out to make money. That's the way our country is ran. Some people develop new technoligies out of greed and some don't, yet you can't discount the overall benefit many of these various drugs/chemicals have given to many people. I am one of those people who would not be able to function well without these prescription drugs. Before I take any prescription medicine I learn about it and make an educated decision as to whether it is the right decision for me. I don't just take medicine on a whim from a pharmaceutical advertisement or through pressure from my doctor or psychiatrist.I don't agree that ADHD is a made up disease/condition. People with this shortsided opinion just aren't educated well enough on this topic. I can see how somebody can have issue with the label that has been given to this disorder because it over simplifies the struggles that people with ADHD experience, but to discount true symptoms that people experience is plain uncompasionate. Hopefully you will never suffer from any kind of mental illness/disorder. And to say that the benefits received from these drugs is purely the placebo effect is another sign of your ignorance. They run various trials on drugs and take statistics on their results to determine if the drug is statistically more beneficial than the placebo. These results are then scrutinized by the FDA before they can be released for prescription use by the public.
Posted by Viridis on August 2, 2003, at 18:22:48
In reply to Re: Straterra approval., posted by Shel Swartz on August 2, 2003, at 15:54:08
I don't think that ADD/ADHD is a "made up" illness, although I suspect that it encompasses a variety of disorders. That's probably part of the reason why it (and many other mental illnesses) require a trial-and-error approach to medication, and frankly, I'm glad to see a range of meds available.
I have very mixed feelings about the pharmaceutical industry -- it is a business, and obviously they're out to make money, yet that provides the incentive to test new drugs and offer a wider range of options to patients. I remain very skeptical about their marketing techniques, however, and always try to educate myself as best I can.
I happen to benefit from Strattera and some other psychiatric meds and no, it isn't just placebo effect, any more than improvement with insulin could be labeled "placebo effect" for a diabetic. It really puzzles me how some people continue to make a distinction between "physical" ailments (heart disease, cancer, etc.) and "mental" ailments like ADD and depression, which are simply the result of the brain malfunctioning instead of some other part of the body. By this logic, Alzheimer's disease, Parkinson's syndrome, epilepsy, and so on must also be bogus, since they too originate within the brain.
There's a lot more that I could say, but I think that nearly everyone here is sufficiently experienced and open-minded to see the flaws in this argument.
By the way (to address the second point) a large study just released shows that doctors live longer on average than people in most other professions.
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