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Skipping Doses Can Be Dangerous for Some ADHD Adults
Q:
My 20-year-old daughter, who has ADHD, skips her Strattera dose on weekends. She assured me it’s OK to do this, despite what her doctor says. Is it? 
A:
ADDitude AnswersYour daughter should not skip her weekend dose of medication. Stimulant medications become effective within an hour or so, and wear off within a given period of time, and so can be used on an “as needed” basis. But Strattera, a non-stimulant ADHD medication (generic drug name Atomoxetine), works by building up to a therapeutic level in the body. This can take three weeks or longer, and the level must be maintained by taking the medication each day at around the same time. If your daughter goes off the Strattera on weekends (or holidays), the level will drop and may take weeks to build back up. Fine-Tuning Your ADHD Treatment Plan: How to End Side Effects Caused By Nonstimulant Medications
Posted by Larry Silver, M.D. ADDitude AnswersWhile Straterra is very similar to anti-depressants, it’s made to treat ADHD. Here’s an FAQ on Straterra: Strattera—ADHD Medication FAQ.
Posted by Penny Williams A Reader AnswersStrattera is not a stimulant. It takes 4-6 weeks to see effects (if any) so taking weekends off is not realistic. Your daughter's doctor seems to be aware of this fact - now you just need to communicate it to her. Strattera has not been shown to be as beneficial to most people as was hoped when it was first marketed. The impact is pretty moderate in comparison to stimulants. There are other stimulants and dosing strategies such as the Daytrana patch or shorter-acting meds. Vyvanse is designed to be effective for 12-14 hours - perhaps your daughter needs to be on a medication with a shorter duration of effectiveness. There is another non-stimulant as well called Intuniv. I would recommend talking with the psychiatrist about other options and take it upon yourself to make sure that “the whole person” is treated. Is your daughter seeing a therapist regularly? Does he get assistance from her college? Are you educating yourself? My son’s psychiatrist asks about those things at every appointment. It is not her job to provide those services, but she is reminding me that those are important components to a total treatment program. Meds alone are not satisfactory. Best of luck to you. Posted by krtsinohio A Reader AnswersYou can’t take time off Strattera because it has to build up (and conversely, when a kid stops taking it, it takes more than a few days for the effects to disappear). Posted by bkm A Reader AnswersI have been taking Strattera for about six weeks, and this week has been the best so far. It takes time—up to six to eight weeks to kick in. I went quickly up to 40 mg twice a day—I thought that was the maximum dose, and perhaps it is for my size/weight. I had been on two other meds first—Ritalin and Adderall and neither did a thing for me, so I didn’t have high hopes for Strattera, either. At first, I expected a “magic bullet,” I think, but the first two meds got me over that expectation! I noticed it was a little easier for me to get to bed at a decent hour and get up at a decent hour at first, but I still didn’t feel very motivated. However this week I cleaned out my computer room, the first real housecleaning I’ve done on my own for a long time. Before, if someone wasn’t coming to visit, I didn’t clean. So now I am more hopeful that Strattera really will help me. Posted by barb912 A Reader AnswersWe recently started taking Strattera and have not seen much benefit from it. We were hoping that it would be the answer. Her focus is slightly improved but not much and her hyperactivity is very noticeable. Our daughter first started with stimulants but lost a great deal of weight and would get really emotional when they would wear off at night. They worked great to help her focus and reduce her hyperactivity, however. We switched to Strattera almost a month ago. It does have to build up in the system. It is my understanding that one would have to take them every day (I don’t think weekend breaks are recommended due to the medication needing to “build up” in the system). Good luck with finding the medication that works best for your daughter. Posted by mjsmom73 A Reader AnswersI don’t believe you can take a medication break with Strattera. It won’t work properly if you do because it takes 3-4 weeks for it even to build up within the system to be effective at all. As a general rule, Straterra isn’t as effective as a stimulant. So, just be observant of the changes. I’m sure it works well for some people, or else they wouldn’t recommend it for ADHD. I think most people with ADHD have a better response to classic stimulants though. If the Straterra doesn’t work well, I’d consider having your daughter try a stimulant. Vyvanse is the most powerful stimulant available. Good luck! Posted by JS This question was asked on the ADDConnect forums. Read the original discussion here.
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9 Rules for Using ADHD Meds Safely
Larry Silver, M.D., is clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C. and director of training in child and adolescent psychiatry at Georgetown University School of Medicine. He is a former acting director and deputy director of the National Institute of Mental Health, as well as the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities.
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