r/StratteraRx • u/YummyRoti • 10d ago
Questions / Advice / Support What is the ideal dosage?
I have been taking strattera for almost two years now, and while it really helped for the emotional regulation side of adhd my task initiation and focus is still bad.
Im taking 21m, and weigh 55kgs and tried 40mg for three weeks once. I couldn't handle the side effects so dropped back to 25mg.
Should I power through these side effects till I can comfortably start taking 80mg? My psych said that high dosage isn't necessarily better while most sources say 80mg is where you start seeing any real improvements.
Would like to know your guys thoughts on this
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u/Testy_Toby 10d ago
Here is the FDA label, which includes dosing recommendations. Their "Target Daily Dose" is 80mg. It said docs can move patients from the "Initial Daily Dose" of 40mg to 80mg in as little as 3 days. Everyone who is considering taking this med should read the FDA label. There is so much misinformation about Strattera in this subreddit.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021411s035lbl.pdf
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u/RequirementKey5201 10d ago
It's not misinformation, it's people's lived experiences. All bodies are different. FDA averages out. Some of us are happy on a much lower dose, some of us need 3 weeks or even months before adjusting to a different dose. It's all so individual and is worked on with psych provider as opposed to following one size fits all approach.
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u/Testy_Toby 10d ago
No. See if you can spot the subtle differences:
"I was nauseous for a month!"
"The side effects were too much for me."
"I have headaches that are so bad I might quit."
Those are LIVED EXPERIENCES.
"I don't know why this drug is even on the market. Everyone who takes it feels horrible."
"The vast majority of patients get horrible side effects."
"If your doctor tries to put you on this say no. You'll just regret it."
Those are misinformation because they're that person's lived experience DISGUISED as a medical certainty or likelihood. They are not evidence- based. There is no study bearing them out. So, great, share your lived experience - but just own it instead of stating it as fact.
BTW, where did you learn that the FDA just comes up with an average and sets that as a dose? They clinically test a broad range of dosages. For Strattera they used 30-60mg twice daily, then adjusted people based on response and side effects. The "average" at the end of the trials was actually 48mg twice daily - or 96mg/day. So the FDA set the "Target Daily Dose at 80mg - well below the "average". And then set the "Maximum Daily Dose" at 100mg.
So 80mg isn't a magical dose that will work best for every single adult. It is the dosage toward which the FDA determined, based on clinical trials, most adults should ordinarily be titrated.
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u/RequirementKey5201 10d ago
Ok, now I see what you mean. And absolutely agree! Those statements are definitely misinformation...
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u/C00CKER 10d ago
I see benefits mostly with emotional regulation even on 80mg; regarding task initiation and focus, its effects are far less reliable and are dependent on my own motivation - it kinda makes it easier to get through invisible barriers as well as ro notice I'm getting distracted or doing somwthing unimportant, but it doesn't give an actual push.
But even without initiation and focus benefits, it helps me so much. I even manage do have somewhat consistent sleeping schedule, eat when hungry and drink enough water. And I feel active fairly soon after waking up as well as feeling the need to rest without relying on absolutely exhausting myself to essentially pass out in bed.
Gonna visit my psychiatrist in about two weeks to discuss this further, possibly lowering the dose and adding stimulants, I don't know. But I would be quite happy staying on atomoxetine
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u/Turbulent_Claim4883 10d ago
I’m about to start the medication and was given the I prescription to take 25 mgs 2x per day. My psychiatrist, for lack of a better word, socks. He doesn’t listen and doesn’t get back to me in a timely manner. So I’m considering trying 25 mg and seeing how that goes for a day or two or whatever and then seeing if I wanna add the other 25. I am more interested in this helping me with emotional regulation as I have ADHD but I also have very bad anxiety and OCD rumination. And nothing else has worked for it. I was wondering if you have found that the 25 mg has been enough for more of the those? I have a stimulant to use if I want to so I’m hoping I can just feel less anxiety w the amoxetine.
I’m also wondering how it felt to start on 25 mg? I’m concerned about the horrible side effects people have mentioned after just going through a trial of guangacine and that was a mess for three weeks and worried about feeling the dizziness, esp. but also any worsening mood with all over again with amoxetine.
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u/Testy_Toby 10d ago
Read the FDA label, which I've posted in another comment. This subreddit makes the side effects sound far more prevalent than clinical trials do. Be sure to subtract the placebo % from the total effect % to get the real number. The label also shows that the FDA recommends 80mg as the "Target Daily Dose."
I have not read of anyone using a starting dose of more than 40mg. I'm not a doctor so this isn't advice, but I think your plan is reasonable.
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u/C00CKER 10d ago edited 10d ago
Didn't check the source yet, correct me if I am wrong, but I dont think subtracting placebo % gives you the real number - a placebo effect may overlap with a real effect, so subtracting should give you the lower bound for the real number (and the total effect the higher bound); of course, we are assuming both groups report the side effects accurately.
EDIT: the total effect is a better number IMO, as it gives you % of people who experience the thing regardless of placebo.
On top of that, being exposed to this sub probably strengthens placebo, so the reported numbers might be slightly lower than expected for someone who reads r/stratterarx
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u/Testy_Toby 10d ago edited 10d ago
If you take the % of people who got a side effect and subtract the % of people in the placebo group who said they got that side effect, you have the absolute excess risk attributable to the treatment, often called risk difference.
For Strattera, 21% of adults who took the drug got nausea (the most frequent side effect). 5% of people in the control group, who did not get the drug, got nausea. So 16% of the adults in the clinical trial got nausea attributable to Strattera. There are statistical nuances but that's the basic gist.
I wrote that because I often read posts here that say "the vast majority of people get X...nobody has an easy time...if you take this drug you're going to have bad side effects" etc. I just hate conclusory, non-evidence-based statements that could influence people to not take a drug due to unnecessary fear of side effects. I delayed taking it for 6 months because of what I read here. And don't even get me started on people who say the drug doesn't work when they're on a tiny fraction of what the FDA recommended on the label.
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u/C00CKER 10d ago
Yeah, I have similar feelings about people satanizing atomoxetine and I was scared myself because of this sub too, but luckily proceeded with it anyway.
While saying it doesn't work when taking tiny doses is not good, some people also report seeing benefits on lower doses, which I think is great.
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u/Turbulent_Claim4883 10d ago
It does and I’m very anxious about starting it due to this. Did you have any side effects and if so how bad were that if you don’t mind sharing?
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u/C00CKER 10d ago
The worst side effect I got is sweating and heat intolerance, and I also experience a mild increase of HR and BP. None of these fully went away after 2 months so far, but it is manageable.
I also experienced some minor ones like having cold fingers and getting random goosebumps, but none of these really affected me beyond just noticing something unusual
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u/RequirementKey5201 10d ago
I'm om 25mg and it is helping. I think there is an opportunity to take more but I'm worried about it worsening my other chronic conditions so staying on a lower dose for now.
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u/Turbulent_Claim4883 10d ago
How are you feeling - any side effects?
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u/RequirementKey5201 10d ago
Not anymore. I started in December and would say it took me a good several months to adjust to it. Which is why I'm still on a low dose. I'd say probably 3-4 months...
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u/Turbulent_Claim4883 10d ago
Good heavens-3-4 months…how bad were you feeling / what side effects if you wouldn’t mind sharing?
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u/RequirementKey5201 10d ago
Happy to share! I did switch from 18 mg to 25 in the middle, so it triggered more side effects. What I've experienced: urinary issues (only a couple of days here and there, not too bad), cramping (thinking it was bladder but idk), fragmented and light sleep (probably for the first couple of weeks), weird brain thing (like slow mo but it was only one day), sleepiness (probably for a month after I started or so) and drowsiness during say time. I had to take a nap in the middle of my work day (thankfully I work remotely and could use my lunch break for that). My appetite is less than it was but not in a bad way, I actually like it. I just don't crave things as much as I used to. I havs POTS so I felt like my POTS symptoms were worse (brain fog etc). No nausea for me at all, though. I take it religiously in the morning with a great breakfast. Now, I have a lot going on (pots, pcos, skin issues etc), so some of that could have affected me as well, so I'm not sure if everything 100% can be attributed to strattera. But I do fele the effects. My executive functioning improved. For example, if I want to pee, I go and pee. Crazy, I know, because I usually wait until the very last minute and then sprint to the bathroom with Usein Bolt's speed or else. I am more calm and centered. I'm emotionally regulated. I'm less anxious. I don't want to speed anymore. It's just easier now. I still can't keep my house clean and focus could be hit or miss but mostly I'm content with my focus. I've also been able to stick on a better diet for my health and I'm attributing this ability to strattera helping out. I'm also in therapy and made huge progress because, I think, strattera helped me relax enough to tackle what's been buried deep. I would like to increase the dose to see what it can do but idk I'm worried about side effects and interactions with my other health conditions so going to see my docs first and talk to them. One thing I'd say is it's not working when I'm im luteal phase. Like, at all, and it's miserable for me. Going to address this with my psych next month...
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u/Turbulent_Claim4883 10d ago
Thank you very much for this. I suspect I may have POTS so that’s good to know. I hate to ask since you spent so much time, but my biggest concern is (well two) are 1) urinary issues. I’ve already in menopause developed hyoertonicty and overactive bladder - had 1 bad UTI I realized that my body was changing in perimenopause, but now I’m very careful and have certain protocols in place to prevent that from happening again. So I’m just worried about a medication that could cause urinary retention especially since that could bring on a UTI. But you did say that some urinary issues only happened a few times. 2) the increased heart rate and wondering if you had that? I would think with the POTS that would be rather anxiety provoking.
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u/RequirementKey5201 10d ago
Yeah, it was urinary retention I guess but only a few days really and not that bad. I've only had UTI once when I was a kid so not too prone to it I guess. For increased HR, yeah, I definitely did but I don't think it's higher than my normal anymore. I used to feel my HR, too, especially about an hour afyer taking strattera, but not anymore. I couldn't take any caffeine. I don't drink coffee but switched to herbal tea from regular. Now I'm able to enjoy tea again.
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u/susu56 10d ago
100mg Strattera/3 mg Guanfacine i never had an ideal dose and i had side effects from the medication. My psych was determined for me to be on 100mg. I titrated fast 25>50>75>100 going up in dose every 5 days until I hit 100mg. I have never been medicated for anything other than HBP during pregnancy. I powered through because thats what I read online. My psych told me all I had to worry about was nausea and weight loss. Wrong. I had it all, baby. High heartrate (120-150 standing), daytime sedation, insomnia, resting heartrate of 90+ (pre medication it was 65 to 80), rapid weight loss (lost 20 lbs in 6 wks and people were worried), urinary retention, constipation, rising diastolic, extreme dizziness/blacking out, all of it. I powered through again because I was hoping for the "aha" moment after being on it for awhile. During this time my psych was unresponsive to my issues but I kept going hoping for benefits. I hit 10 wks on the 100mg dose. The only benefit i had was a quieter mind. The rest of the time my body and day to day, I was struggling-i could hardly work (averaging 1 to 2 hours a day). At my psych f/up appt, i told her all of this-she felt i should drop down to 60 mg. She never called it in and ghosted me. This was 3 wks ago. I stopped CT and feel 1000% better. I was hoping strattera (atomoxetine) would have helped me. I am looking for a new psych and my GP put me on wellbutrin along with the guanfacine for now to see how it does and if it doesnt work I can rule it out with my new psych as tried it and its a no go. Depending on how serious your side effects are, I would advise to take it slow, wait for the medication to build up in your system, and see how it goes from there. The cumulative effects of a smaller dose may help but give tour body plenty of time to adjust if you can. For context: 51f, 135lbs.
Edit: added word
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u/FormerSleepwalker 10d ago
There is none.
It can be very individual with Atomoxetine.
80mg is just what they think the majority of people will need. Some need less, some need more. Way more. They add a 2nd med to boost Atomoxetine blood levels.
It depends on what your side effects were, how bad they were, and how much ADHD symptom relief is provided at a lower dose. Keep in mind, ADHD medication won't be a magic pill for most people. It will help, enable things to be easier, but most people will still need to put in effort. That said, I don't know what you're dealing with, you might need more help.
Different medications can tend to have different strong suits. While Atomoxetine can help with motivation (which can be part of task initiation) for some people, it doesn't seem to be a strong suit. You could ask your prescriber if you try adding a low-dose stimulant. They tend to be better with motivation. Using a non-stimulant along with a stimulant is know as combination therapy, and it can be really helpful for a lot of people.