Strattera (wasn't sure where to post this)

Thunderwolf, MSN, RN · Oct 29, 2005

My first thought was to move this thread to Psychiatric Nursing forum, but I chose not to since RNin2007 is asking for "a general response" from membership regarding their own children/family success with it...not a "specific" concern about the medication itself as a topical focus.

My rationale.

vidrine rn · Oct 29, 2005

:specs: my son took straterra for a few days, he had adhd. well he developed

these terrible tics. he would just jerk and could not controll it. i took him off of the med. his tics remained for weeks. then the tics finally stoped. school started and the teacher was complaining. he could not sit still long enough to consentrate on his work. so the doc put him on adderall xr. the results are amazing. no tics no more bad notes from the teacher.

LydiaNN · Oct 29, 2005

I discussed Straterra with my son's ped, but after listening to his rationale about why he didn't think a trial was likely to be successful, opted to keep our son on Adderall. The Adderall is very effective, but it plays games with his appetite and makes it difficult for him to unwind at night.

lsyorke, RN · Oct 29, 2005

Strattera now carries a warning that is the same as antidepressants for suicidality. It is actually an SNRI (similar to Effexor) antidepressant and can have many side effects.. tics just being one of them.

Finallyat40 · Oct 29, 2005

My 10 yo, who was a 29 week preemie, has been on Strattera for the past two years. It has worked quite well for him....don't get me wrong, we still have bad days, but nothing like we used to have. The only problem we had was lack of appetite when taking it in the morning, so after a bit of research, I switched him to nightime dosing and his appetite returned. I realize that there will probably be a day that we have to move up to the stimulant meds, but I'm really thankful that this has worked so far!

Jamie

RNin2007 · Oct 29, 2005

Nice to hear the different sides of this med. My son was also a 29 week preemie. I forgot all about the doc saying to watch for tics so I will have to keep my fingers crossed. And I had no idea about the new FDA warning either. I will definitely follow up with some research, but I sure hope it continues to work like it is.

=)

~J

VickyRN, MSN, DNP, RN · Oct 29, 2005

Excerpt from FDA advisory (there have actually been two advisories in less than a year concerning this medication):

FDA Alert [09/05]: Suicidal Thinking in Children and Adolescents
The Food and Drug Administration (FDA) directed Eli Lilly (Lilly) to revise the labeling for Strattera to include a boxed warning and additional warning statements regarding an increased risk of suicidal thinking in children and adolescents being treated with this drug. In addition, a Medication Guide will be prepared to provide directly to patients, their families, and caregivers information about the risks mentioned above. The Medication Guide is intended to be distributed by the pharmacist with each prescription or refill of a medication.
Strattera is currently approved in the United States to treat ADHD in children, adolescents, and adults. Strattera has not been studied in children under 6 years of age.
Recommendations
Pediatric patients being treated with Strattera should be closely observed for clinical worsening, as well as agitation, irritability, suicidal thinking or behaviors, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. This monitoring should include daily observation by families and caregivers and frequent contact with the physician.

http://www.fda.gov/cder/drug/InfoSheets/HCP/atomoxetinehcp.htm

http://www.msnbc.msn.com/id/9529101/

An earlier FDA advisory warned of possible liver injury associated with strattera usage:

http://www.medicalnewstoday.com/medicalnews.php?newsid=18014

lsyorke, RN · Oct 30, 2005

Please realize that long term use clinical trial studies of antidepressants have not been done. The longest clinical trial was for 12 weeks. We are seeing long term adverse effects that have been reported to the FDA in adverse reactions reports. Use this drug VERY carefully!

Jolie, BSN · Oct 30, 2005

to RNin2007,

I hope you don't mind me asking. Would you be willing to tell us a little more about your son's clinical course during his NICU stay, and growth and development since? The reason I ask is this: I am a NICU nurse who has very little experience with older children. For the most part, once a baby is DC'd, the parents will keep in touch for a while, then contact tends to drop off after a year or two. This is perfectly understandable, as they no longer have a need for NICU support, and are trying to focus on their growing child, not re-live the past.

I have always had the impression that infants who develop PVL are pretty much doomed to a lifetime of significant developmental problems, such as sensory and intellectual deficits and CP. Clearly your son has some challenges, but from your description, he is functioning at a much higher level than I would have ever expected for a child with PVL. Are his abilities typical for a child with PVL, or has he progressed farther than you were told to expect?

Thanks for any information you can provide. I'm not trying to pry, just educate myself to the realities of our NICU graduates. Thanks!

Wanda950 · Oct 30, 2005

My son is nearly 8 and has been on Strattera for 1 year. His dose was changed from 25 mg to 35 mg daily 2 months ago. We have had no problems with the med and are very pleased with the results.

RNin2007 · Oct 30, 2005

No problem at all, I love sharing info and hope to be an NICU nurse in just a few years myself =). He was my second preemie (my first was a 26 weeker, 680 grams...PDA ligation, no other complications, straight A student now...11 yrs old). My son was 29 weeks, 970 grams and he was an absolute wreck in the NICU! He had a meconium ileus at two weeks of age, which was surgically repaired. He wasn't able to take breast milk for over a month. Then he developed hydrocephalus, which we discovered was congenital due to aquaductal stenosis. He had a reservioir put in b/c he was too small for a VP shunt, then recieved a VP shunt before we went home. But before he got his VP shunt, he had a double bilateral inguinal hernia repair. He basically was sick all the time, had an infection in his brain (PVL was discovered within a few weeks of his birth) and was on the ventilator for over 2 months. I was able to pump breast milk and spent probably 12-14 hrs a day in the NICU holding him skin to skin, and participating in his care as much as possible. It was a completely different experience from my daughter (26 weeker) who did so well! They are three years apart.

He finally came home after 4.5 months, and then had two shunt revisions within the next year. He's had 8 surgeries in all. You honestly would never know it. He has an incredible sense of humor, he is right on target for his height/weight and is one of the most affectionate kiddos I know. Here are a few pictures =).

http://i5.photobucket.com/albums/y164/arwenaragorn/2666a8d6.jpg

http://i5.photobucket.com/albums/y164/arwenaragorn/DSC01934.jpg

My desire to become a nurse was inspired by all the nurses I had contact with in the NICU. And of course with as many months as I spent in there, it became intriguing to me. I am in the middle of writing a handbook for parents, from a parent perspective. It turned out really nice...I am nearly done with it, but need to wait until I have time to attempt to find a grant to get it published (I want to donate it to hospitals for parents, not make money from it).

His major problems were in cognition...writing expression, but nothing severe. The report we recently got from his neurophsych exam said about the findings "these neurobehavioral complications are definitely having an impact on this child's ability to function, and his wonderful demeanor and individual prose may be resulting in difficulting in identifying his subtle but significant educational difficulties."

With all he went through, I feel truly lucky that he really has minor problems. It could be so much worse.

Thanks for asking!

~J