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Monthly NewsNote
June 2004
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STRATTERA ONE YEAR LATER
About a year and a half ago Strattera became available for the treatment of ADD.
Over that time I have been able to prescribe the medication, follow the literature,
and discuss experiences with colleagues. The summary statement based on my findings
and those of my colleagues would be: Strattera is very helpful for some children
and adults, of limited use for others and of no use for most.
The major positive points about Strattera are that: 1. It usually has less
impact on sleep and appetite than the stimulants and 2. It is in effect for
24 hours. These are major pluses.
Many kids need medication early in the morning to get the day started. With
a stimulant we may have to wake the child at 6 AM for medication, let him sleep
for a half hour while the medication starts to work, and then get him up to
start his day. Obviously, having a medication that is working when the child
wakes up is highly beneficial.
One of the main problems is the length of time before onset of action. It generally
takes 2 to 4 weeks and longer in adults before you know how well the medication
is going to work. This can be a long time, particularly when a student is having
trouble in the middle of a school year.
At times Strattera can be combined with a stimulant for improved over-all results.
Eddie, age 9, is an example of that kind of situation. His response to Strattera
was showed mild ADD improvement, but not enough for his situation. Stimulants
worked well, but reduced his appetite and made falling asleep difficult. When
I gave him a combination of RitalinLA for school and a daily dose of Strattera,
it worked nicely. The Strattera was strong enough to get him through homework,
and he was able to eat supper and fall asleep on time.
Adults can be helped with Strattera, though it can have some significant side
effects. These include intestinal difficulty that does not go away, sexual problems,
and difficulty urinating in men, particularly if there is a prostate problem.
I have tried it with many adults, and it does not work often. However, for
a person with a substance abuse problem or history, it would be a good medication.
I have tried it with eleven such adults and it has helped two.
As school ends and many pressures are reduced, I think it is a good time to
try the medication if the need exists. This would include underweight children
or those who have some problem with their regular medication. It can be started
without taking them off a stimulant, and after a few weeks the stimulant can
be discontinued and the effect of the Strattera observed.
As time goes on we are gaining more experience with Strattera and doing such
things as trying higher doses and waiting a longer period before deciding it
doesn’t work. However, at the moment it is an addition to our medications
for ADD, but not a shining light.
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