Stratera, FDA approved in December of 2002, is our newest drug for treating ADD. Although it is not technically a stimulant, it’s effects are very similar to the stimulant class of medicines and therefore we suggest you read about stimulants before reading about Stratera. The reason the effects are so similar is that both medicines work by increasing the activity of a neurotransmitter called Norepinephrine (NE) in the brain. NE is one of the two neurotransmitters (the other being Dopamine) which appear to be “under-active” in the brains of ADD children. Stimulants and Stratera increase NE activity through different mechanisms, however. Stimulants simply “stimulate” the production more NE. Stratera is instead a “selective NE reuptake inhibitor”, which means that it slows the clearing away of the NE that’s already there. This allows that NE to “hang around longer” and have more of an impact. What’s best, it does this selectively, only in the parts of the brain which control attention, in contrast to the stimulants which increase NE throughout the whole brain and indeed the rest of the body as well.
Because of this difference in the way it increases NE effect compared to stimulants, Stratera promises for many patients to have all the advantages of stimulants with few if any of the disadvantages. Studies and clinical experience so far indicate that the overall incidence of side-effects with Stratera is much lower than with stimulants. The most common side effect, stomach ache, is usually transient and only lasts for the first week or so of treatment, then disappears. Because of this we often prescribe a lower dose for the first 4-14 days of treatment, and then move up to the therapeutic dose (which is usually 0.5 to 1.2 mg per kilogram of body weight per day). Tics and emotional/psychiatric problems can be exacerbated as with stimulants, but this happens far less frequently. The sleep, appetite suppression, and growth problems we see with stimulants don’t seem to be an issue at all with Stratera. Stratera comes only in capsule form and, when taken once every morning, the effect lasts 12-18 hours.
At CMO we are very enthusiastic about Stratera and we’ve been using it a lot since it came on the market. So far our experience with it, and that of our patients, has been very positive. The biggest disadvantage it has is it’s newness and it’s price (related issues). Because it is more costly than more traditional stimulants, many insurance companies will not routinely cover it, or may require evidence that a patient has had unacceptable side effects on several stimulants before they will cover it. Also, it must be cautioned that, as with any new medicine, we may ultimately discover risks associated with Stratera that we don’t yet know about. Barring that occurrence, however, we expect with time Stratera or newer drugs in the same class may eventually replace the stimulants standing as “first line” treatment for ADD.