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Strattera (Atomoxetine HCI)

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  #1  
Old 04-28-09, 12:40 PM
82insomniac 82insomniac is offline
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Exclamation Strattera and Ritalin? Help please...

I'm currently on 80mg of Strattera that I take once a day, in the evening. When I started taking Strattera a month ago I took it when I got up in the morning, but it makes me so tired that the doc told me to start taking it before bed.

I slept 13 hours one night, got up the next day feeling great/awake/alert. I got to school and realized I had forgotten to take my Strattera, so my husband brought it to me and I took it @ 9:00. From 9 to 10 I felt my body relax, my mind slowed, i was able to listen to the lecture. About 10 I started getting increasingly drowsy and by 1:00 I fell asleep, in class, while I was taking a test!

I have a very difficult time studying because I fall asleep over and over again. With finals approaching I asked the doc today if there is anything we can do to help me stay awake so that I can study and he wrote me a prescription for Ritalin to take in addition to the Strattera.

Has anyone ever taken, or heard of taking, both at the same time? The pharmacist says there are no drug interactions between the 2, but he's never heard of taking both at the same time. He said usually people just switch.
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Old 04-28-09, 12:48 PM
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Re: Strattera and Ritalin? Help please...

yes i'm taking both at the same time. i've read around and apparently it is not uncommon to take a stimulant with strattera to offset the drowsy effects, as well as giving increased focus. so far its worked good for me.
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  #3  
Old 04-28-09, 01:01 PM
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Re: Strattera and Ritalin? Help please...

Thanks so much. It didn't seem all that weird to me at first, but when the parmacist told me the Strattera shouldn't be making me tired and he couldn't figure out why I would be taking both, I started to stress out about it.
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Old 04-28-09, 08:51 PM
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Re: Strattera and Ritalin? Help please...

I've posted to this around somewhere before.


Yes. you can take Ritalin alongside Strattera. Given the following conditions.
I've suffered with ADD (ADHD) whatever you want to label it as, since I was a kid. I'm now in med school (after being told I would never amount to anything) and one thing I can say is that people react differently to different medications.


Strattera is a NRI, a norepinephrine re-uptake inhibitor. It takes at least 2 weeks to work and sometimes as long as 4-6 months. Sometimes people can notice tolerance, and then a temporary dosage decrease, then increase again is necessary.

Theoretically, Ritalin acts differently than amphetamines, it blocks the re-uptake of NE, and Dopamine. Specifically via the Substantia Nigra pathway to the Prefrontal cortex (our major executive function center) and increasing the re-uptake of glucose.

ADD is thought to be a developmental delay, more than a disorder, but if left untreated, then it becomes a disorder more than a delay. (unfortunately my case).


So. to the point.


After strattera has been allowed to work at the "target weight dose" you should need LESS stimulants than originally taken because of that re-uptake of NE, one of main neurotransmitters thought to be involved in attention etc.

I currently take 80mg strattera in the morning, and 10mg ritalin "toppers"
whenever really, to temporarily boost my focus. But I find that if I take too much Ritalin, given the strattera on board, that it's not that helpful.


One of my strattera concerns however, is that I seem to be feeling rather blue and down lately, for no reason, and my sleeping sucks.

So perhaps that's the ritalin, or perhaps the Strattera just isn't for me.


I've only been on it 3 months, so I;m giving it until July, since I started in December, and make the decision then. my doctor tends to work with me, rather than FOR me, which I appreciate.


Anyway, hope these insights helped you.


Good luck

-R
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  #5  
Old 04-29-09, 12:53 AM
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Re: Strattera and Ritalin? Help please...

Thanks surferdude. I REALLY liked your response. I'm the kind of person that has to know why things do, what they do. If I can't figure it out, I have a really hard time accepting it.

I understand it'll take a while to perfect the Strattera dosage and for the side effects to wear off.

I'm also find myself feeling down some days for no apparent reason, but other days I'm in a surprisingly good mood.

Thanks again
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Old 04-29-09, 01:27 AM
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Re: Strattera and Ritalin? Help please...

yes knowing why for things makes a huge difference.

Ask your doctor about Effexor XR and Ritalin, that combination has been shown in academic literature to be quite promising.


I'm beginning to question Strattera myself, as sometimes I feel down, for no reason. It's rather silly. I know Ritalin works for me, and I know it has proven efficacy for over years of treatment.

One thing I need to stress to you though is no matter what med you are on (aside from Antidepressants and Strattera) but like Adderall, and Dex, etc. is to take at least 1-2 drug vacation days per week. Some are against this.

But trust me. It works.

and eat more than average for protein when you're on Strattera as well, as it's highly protein bound.



-Robert
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  #7  
Old 04-29-09, 05:04 PM
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Re: Strattera and Ritalin? Help please...

robert, is it important to eat more protein throughout the day, or just when I take the Strattera? I'm glad you told me about the protein. I looked it up again in my drug book and it definitely says it's 98% protein binding. I can't believe I missed that when I looked it up initially.

I go back to the doctor for another follow up visit in 5 weeks. If the Strattera is still making me extremely tired I will ask about Effexor XR and Ritalin. I could be wrong, but the doctor seems really uneasy about prescribing Ritalin. When I expressed to him my concerns with me being so tired and all of the tests and finals I have in the next 3 weeks he gave me a script for 14-5mg pills. I didn't specifically ask for Ritalin, I just asked him if there was anything we could do to get me through the next few weeks.

I haven't taken the Ritalin yet, but I am hoping it will help keep me from falling asleep while I'm trying to study.

Lindsey
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Old 04-30-09, 03:22 AM
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Re: Strattera and Ritalin? Help please...

yah 98% sounds about right, thanks for checking on that.

Yah, try to mix protein and carbs together if you can.

For example the other day I had a tuna fish sandwich with lettuce, mayo, and the tuna fish was packed with 100% olive oil (omega 3) instead of brine, and after I ate the sandwich I felt clear again, instead of tired. Very strange.

Re: Ritalin, do you have a hx of drug abuse? is that why the doctor is reluctant?

He also probably wants to give strattera a decent try, (as in 2-4 months) before trying other meds.

Effexor and Ritalin work well together especially for Co-morbid anxiety.

Remember, I'm not actually prescribing here, I'm suggesting, as what I've read in the academic literature, and what I've seen other patients take.

depending on your weight, the standard dosage is 2.0 mg / kg (converted from lbs) per day of Ritalin, to a *legal* max dose of 60-80 mg.

I've *HEARD* of dosages ranging from 80-110 mg per day, of ritalin in RCTs and in the literature, but the safety hasn't been established, the highest I've gone was 80 and I felt burnt out. I try to stick to <60 mg a day or less with at least 1-2 days break every week.


oh, and also, remember to drink a lot of water as well, Ritalin, Concerta, and Strattera are eliminated by the kidneys and liver (strattera), so you want to keep them healthy


-R
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Old 04-30-09, 11:36 PM
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Re: Strattera and Ritalin? Help please...

haha, I just finished eating a tuna sandwich about 5 min before I got online and read your post...weird...but, you're right, I feel clear again.

No hx of drug abuse here, so I'm not really sure why my doc is hesitant. It could be as you suggested and he just wants to give the Strattera a long enough trial.

Yeah, I definitely drink a lot of water. I don't care for soda or sugary drinks and The Strattera makes me so thirsty that drinking plenty of water is easy to do.

I took a Ritalin this afternoon. It gives me a weird feeling. Not necessarily bad though. I was able to focus even better than I do with the Strattera alone. I was still kind of tired, but I felt like something kept pushing me to do just a little more, granted I still didn't accomplish a lot this afternoon, but I did more than I would have otherwise.

I feel like Strattera just slows my brain down, where Ritalin seems to help me actually focus and concentrate better.

lindsey
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Old 05-02-09, 01:50 AM
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Re: Strattera and Ritalin? Help please...

interesting about the protein.

I like tomato sandwiches!! sounds weird but they are good

I've never really drank soda, or sugary stuff, I did a moderate amount when I was younger, but for the past 9 or so years I haven't.

Interesting you say that about Ritalin. I recently read a research journal stating that too much NE reuptake actually retards mental and cognitive functioning. Makes sense given it's actually a stress hormone. We need a certain amount to make the good ole pre frontal cortex to work, but too make makes us tired, and sleepy.


I have PM'ed you my email address and contact information if you want to print it off and give to your doctor.

It sounds like you might be a preferential responder to Ritalin and stimulants, as opposed to Strattera.


** on a side note, I stopped Strattera yesterday, and I feel 100% better already and it's only been a day.

feel free to get in touch with me and I hope you can find something that works and stick to.


Robert
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Old 05-02-09, 03:24 AM
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Re: Strattera and Ritalin? Help please...

Also, watch out for comorbid disorders! For example, Tourette's is often seen alongside ADHD, and the symptoms can sometimes worsen if a stimulant ADHD med like methylphenidate (Ritalin, Concerta, Metadate) is taken. However, Strattera may actually be useful as a medication treatment for Tourette's (as well as ADHD, obviously).

Speaking of Strattera, there was a recent publication that just came out on how Strattera's effectiveness or dosage levels may be affected by an individual's genes. The gene SLC6A2 is on the 16th human chromosome, and comes in different forms, some of which result in a much more positive or effective response to Strattera than others.

The reason I bring this up is the fact that there is a real amount of variability as far as the response to a particular medication goes, and genetics can play a major role in this.

Additionally, another gene, CYP2D6 (located on the 22nd human chromosome) is believed to play a role in the metabolism of both Ritalin and Strattera, so there may be potential complications with the metabolism or clearance of the two drugs by the enzyme coded for by this gene. Some individuals are what is called "genetically poor metabolizers" for CYP2D6, that is they have poor clearance with this gene and its enzyme. There is one study that I know of that cautions about using atomoxetine (Strattera) and methylphenidate (Ritalin) together if one is a "poor metabolizer". It highlights a case of combined overdose for the two medications.

I wouldn't worry too much about the combined overdose effect of the two meds (I'm assuming you haven't been genetically screened to see if you're a "poor metabolizer" candidtate for this CYP2D6 enzyme), however, as long as your doctor isn't prescribing any megadose levels of either medication. Just something to keep in mind, especially if you begin to feel any sort of negative effects when combining treatment with the 2 ADHD medications.
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Old 06-04-09, 02:34 PM
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Re: Strattera and Ritalin? Help please...

@surferdude123 you said that one may need to take Strattera from 4-6 months to see if it works for them. I think it is actually 4-6 weeks, at least from what I have read.

Diet: I am on the Anabolic Diet which consists of high fat and high protien mon-fri. I have way more concentration than I did when my diet stunk. On the weekends I get to eat as many carbs as I like.

I use to combine ritilan + strattera but since I am on this diet I haven't felt the need to do that. If I need a stimulate I usually drink a couple cups of coffee (german coffee from Aldi) through out the day.
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Old 10-28-10, 05:34 PM
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Re: Strattera and Ritalin? Help please...

Recently doc switched me from Ritalin to Strattera and I've been soooo tired I can't wake up for group therapy. I have to leave the house at 8 to get there on time. I've never been on time... thats an issue regardless of med!

I feel like taking my leftover Ritalin just to wake up! If I do that, I question the reason for the strattera.

It's only been a few days, so I'm giving it time. Meanwhile I'm a costume designer and I have 4 shows going on in the next two weeks! High school plays... not Broadway or anything, but the show must go on!
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Old 10-28-10, 05:45 PM
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Re: Strattera and Ritalin? Help please...

Quote:
Originally Posted by 82insomniac View Post
Thanks surferdude. I REALLY liked your response. I'm the kind of person that has to know why things do, what they do. If I can't figure it out, I have a really hard time accepting it.

I understand it'll take a while to perfect the Strattera dosage and for the side effects to wear off.

I'm also find myself feeling down some days for no apparent reason, but other days I'm in a surprisingly good mood.

Thanks again
aND THANK YOU 82insomniac... I thought I was alone in the fact that I need to know why things work. I took an automechanics class at 17 just so I could learn to drive knowing what took place under the hood LOL.

Im trying strattera.. so far I've slept alot and Im kinda impatient to feel the results of this med. :P But I will give it time.
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