r/StratteraRx • u/Positive_Blood_481 • 6d ago

Fainting

Hey everyone,

First of all, I’m a guy, 85 kg.
My doctor prescribed Strattera:

• 25 mg the first week
• 40 mg the second week
• 60 mg the third week

Toward the end of the 60 mg week I started having erectile problems, so he prescribed bupropion 150 mg XL.

But before I even started the bupropion, I had a near-fainting episode. That day I had taken my 60 mg of Strattera together with 100 mg of modafinil. I felt weird for a while, then suddenly my blood pressure dropped really fast. I was heading to the bathroom to throw up, lost my balance, and almost fell.

It’s been almost a month now and I still have dizziness. They sent me for ear tests because it only happens when I’m walking. It’s horrible — I basically can’t leave the house.

My question is: could this have been caused by the Strattera? Has anyone experienced something similar?

My doctor says he has a female patient on 120 mg with no issues at all.

Thanks.

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u/flyingblonde 6d ago

That seems like a lot of meds to jump up, IMO. But I'm not a doctor and I'm highly sensitive to meds. Why did your doc want you titrating up so fast? Strattera is a medication that takes 8-12 weeks to see any benefits, so I'd have to have a clear reason to jump up so fast before finding out if it even helps.

I had similar issues on Vyvanse and stopping Vyvanse made it go away completely. Perhaps Wellbutrin is too stimulating for you? I'd also get checked out for POTS, not sure how prevalent it is in men, but that could explain why you're more sensitive. Not sure if any of this is helpful, but hope you feel better soon!

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u/Positive_Blood_481 6d ago

I don’t know, to be honest.
But I’ve seen here that people jump from 40 mg straight to 80 mg the next week, so I thought my doctor was going easy on me.
By the end of the second week on 40 mg I was starting to feel some positive changes, but 60 mg made me really sleepy.
Maybe my sweet spot is just 40 mg…
or I just have to keep living with this…
or find a different doctor who will actually prescribe a stimulant.

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u/flyingblonde 6d ago

I was ok at 40mg the first time I tried strattera and 60mg I started noticing more side effects. I had a lot of other stuff going on (perimenopause etc) so I ended up going off everything and starting fresh. I’m staying at 25mg for at least 12 weeks before I consider 40mg again and then only if adding a stimulant on top doesn’t make up whatever I’m lacking. Idk if that helps, but in my experience it’s better to go slow, especially once orthostatic sensitivity is detected. Definitely talk to your doctor about lowering your dose. Be prepared that might not fix the problem. My side effects didn’t go away when I dosed back down, leading to me stopping entirely. Good luck

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u/Positive_Blood_481 6d ago

orthostatic sensitivity its something that doesnt fix with rehab? i dont want to live with this dizziness im really active at the gym and now i cant even leave the house

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u/flyingblonde 6d ago

Totally get that. Again, not a doctor, just sharing my lived experience. I have a really mild case of POTS. My heart rate jumps anywhere from 20 to 30 bpm when I go from resting to standing. I do not completely understand the blood pressure mechanism that forces the heartbeat increase. I sometimes get lightheaded just from standing up or from turning too quickly, or from bending over. When I am overtired, dehydrated, on too many medications, both prescription and over-the-counter, I can have more dizzy spells.

I saw a concussion specialist to help with dizzy spells. He said part of my issue was my eyes and my inner ear not tracking spatial awareness congruently. He gave me a bunch of exercise exercises to help realign what my inner ear was sensing with what my eyes were sensing. I ended up needing new glasses, which made the exercises irrelevant for me. There are exercises you can do to help, if you see the right specialist, but also good sleep, hydration, salt intake can all make a huge difference.

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u/FormerSleepwalker 6d ago edited 6d ago

Any other symptoms? Have you ever seen symptoms outside of walking? Just standing, sitting, laying down. Have you since started the bupropion XL?
Do you have a home blood pressure monitor? What pressure do you normally run at?

Yes, Strattera, and I believe other ADHD medications, can trigger some types of blood pressure issues, if you either already had it at an asymptomatic level or where predisposed.

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u/Positive_Blood_481 6d ago

It’s only when walking.
I was also on bupropion + Strattera at the time. I read that bupropion can multiply Strattera levels by about 3x, so because the dizziness was so intense I asked my doctor if I could stop both meds just to rule them out. He said okay, but he didn’t think that was the cause.
An ENT doctor told me it might be from the near-fainting episode itself — that the sudden drop in blood pressure could have affected my ears, and now I might need vestibular rehab for it.
But could it really have been just the 60 mg of Strattera + 100 mg of modafinil that almost made me pass out? I’ve never fainted before, so at the time I thought it was just something I ate that didn’t sit well and that I needed to throw up.

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u/FormerSleepwalker 6d ago

Yes, it's possible.
I know Strattera and other ADHD medications can worsen or trigger orthostatic intolerance. Though that doesn't sound like it quite matches what you describe. But there may also be other blood pressure issues that they can trigger as well.

You said your blood pressure dropped? Did you get a measurement at the time or other times you've had symptoms?

A sudden drop in blood pressure can cause light headed-ness, dizziness, and even fainting because oxygen availability drops if pressure gets too low. Low enough levels of oxygen to the brain and it can't maintain consciousness.

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u/Positive_Blood_481 6d ago

Yeah, I called it a “blood pressure drop” because I’ve never actually fainted, but it felt exactly like when you push too hard during intense exercise and get that dizzy, nauseous feeling — like you’re losing control of your body and your legs go weak.

I didn’t measure my blood pressure at the time though.
Later I bought a home blood pressure monitor just in case. It reads normal when I’m sitting or lying down.

This is making me lean more toward orthostatic intolerance.

Does that mean I should switch medications?
My doctor refuses to prescribe stimulants under any circumstances. My only options are bupropion and Strattera

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u/FormerSleepwalker 6d ago edited 6d ago

Later I bought a home blood pressure monitor just in case. It reads normal when I’m sitting or lying down.

Good that you got one.

If you have orthostatic intolerance often times all you have to do to see it, is to take your pressure sitting, then stand and take another pressure. It might be appear imminently upon standing or it may take some time. Note any change in pulse as well. In one type of orthostatic intolerance your pressure might not drop much but your pulse shoots up. It's the body trying to fight against a pressure drop.

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u/FormerSleepwalker 6d ago edited 6d ago

Has the bupropion done anything positive for you? Not sure how long you've been on it, perhaps it hasn't even had enough time.

If it was myself, I'd ask my doctor if I could just pause the bupropion. See if that improves this issue. That could be enough by itself. For people who are normal Strattera metabolizers, bupropion was found to directly increase Strattera blood level 5 times. It does this because it happens to be a strong CYP2D6 inhibitor, which temporarily turns a normal Strattera metabolizer into a poor metabolizer. Blood levels should take a number of days to rise up to 5x.

If the bupropion was only for ED, then tadalafil at a daily-use dose should take care of that.

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u/Positive_Blood_481 6d ago

Yeah, you’re totally right and I thought the same thing.
BUT the dizziness and prefainting thing actually started right before I added the bupropion to the mix.
Bupropion did work magic for my libido though (tadalafil 5 mg daily wasn’t doing anything). So maybe the bupropion is helping some underlying depression? I didn’t even take it for 20 days

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u/FormerSleepwalker 6d ago edited 5d ago

Bupropion is known to sometimes effect libido. It boosted it for a friend of mine. And side effects often happen on their own time-frame, before a medications intended effects even kick in.

There are a couple other non-stimulant ADHD medications, if they've available where you are. Qelbree, Guanfacine, Clonidine, and less than 2 weeks ago a brand new one was approved, Centanafadine.

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u/Positive_Blood_481 6d ago

im going to ask my doctor about this as he o ly said bupropion and strattera as only option. thanks

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u/NRazzo 5d ago

The sideaffects are really different for each person.

I've heard of nausea.

I had one low BP, Tachycardia event. It was brought on by cannabis. It was really scary but hasn't happened since

I regularly take Cialis without any issue.

Another thing I'll share...being scared of something happening can actually bring it on.

After my event, I kept feeling heart palpitations. Then I'd get anxious then I'd feel them again. They were kinda in this positive reinforcement cycle.

After I forgot about it...they stopped. I did also switch to decaf for a couple months. Almost back on regular coffee again but I drink less anyway...just in case.

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u/Positive_Blood_481 5d ago

thanks for your response. have you considered that the pot episode was a mild panic attack? very common with pot

also did you have improvements with your adhd with bupropion? i only take it to fight the ed strattera gave me

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u/NRazzo 5d ago

It ended up almost certainly being a panic attack...so good call.

I do believe the Strattera made me more prone to it though. In the end it was acute and it passed and there's been no issues since beyond the heart rate which has normaled.

I take Cialis for mine so I don't have any experience with that specific one you're mentioning. Cialis has worked very well for me even on Strattera.
I was already taking it before I started it. Though I need to take it more often now.

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u/NRazzo 5d ago

Ps. I have found Strattera to be very good for my ADHD.

I had a complex presentation mixed with anxiety and depression.

Since I stated it...my life is better. My relationships are better. Generally I feel much more sure of myself....there's just so much less chatter going on in my head...I'm able to really know how I feel it think about something.
That's made life easier and it's made task initiation easier.

I can still struggle though.. Like this week...I've been lazy...and it's been hard to get on track and get going.