Atomoxetine for my Son

[NK25CA]

Hello Everyone, my son aged 14 years diagnosed with ADHD and taking this medicine 36 mgs at night at present, earlier he was on 18 mgs , his behaviour improved a little but he is still different from other kids, his activities slowed down a bit but attention is not there to do things like other kids do ! Can any one tell me what is the ideal dose as he weighs 60 kgs and 178 cm tall , Thank you

[GoDukes]

There is no ideal dosage that works for everyone. It is always going to be an individual thing. The Atomoxetine is not known for helping as much with focus issues. Stimulant medications are typically better for that. We noticed too many side effects with stimulants so we switched to Atomoxetine. Sometimes you have to trade off. Good luck!

[MumLuvBubs]

It’s all trial and error unfortunately. My son who’s 11years old with ADHD does not like group sports (waiting for his turn, gets bored), so I recently put him in boxing with a one on one trainer. He loves it and it’s the only way he’ll do it. I first tried fencing, but the trainer was an older gentleman who was clueless about ADHD so my son went once and didn’t go back. His boxing trainer is a senior in high school. He’s a great kid who also likes to play video games (my son’s favorite). I’m really grateful to have found him as I feel if he was older my son wouldn’t be as into it (possibly would not have gone back). Maybe you can find someone closer to his age who’s great at sport or whatever he’s into to train him in something he might enjoy.

Good luck!🙏

[Hidden]

You could check BNF.org.uk

British National Formulary (BNF) offers Key information on the selection, prescribing, dispensing and administration of medicines. You can search Atomoxetine in their index and it says clearly best practice guidance in starting it, it states the maintenance dose which is 1.2mg per 1 kg body weight, it also lists all the side effects.

Going by medication leaflet which I have just looked up in my son’s box with Atomoxetine (he also is on this medication like your son) it states clearly that maintenance dose is 1.2 mg per 1 kg body weight.

However about 10 per cent of people metabolise this medication differently and they do well on lower doses. In US you have tests for it. In the UK this is checked by slowly over weeks increasing dose.

Considering what BNF and the leaflet says, I’d say your son is on a too low dose for his weight, however it might be that his doctor is careful and wants to increase slowly until reaching the right maintenance dose.

I’d say- until my son got to the right dose for his weight, we didn’t see full therapeutic effect. My son is only 10 years old and he is now on 40mg once per day in the morning. It works well for him, he doesn’t suffer any side effects and overall it is helping him with his ADHD symptoms. It’s not perfect though but I know there is no perfect medication.

Oh and good to know that to see full therapeutic effect- with this medication you need to wait up to 6 weeks on a right maintenance dose to see full benefit. It kind of builds up in the system.

[amewhit]

According to his weight his maintenance or therapeutic dose is 72mgs. Above poster is correct - some people metabolize quicker and need a lower dose. But if he doesn’t have any bad side effects I would slowly increase to 72mgs or around there. My son is 12 and 50kg. There was a little improvement as we started increasing the dose - once we hit 60mg it was so much better. It is not perfect. Focus is not great still but his energy and mood is greatly improved. He also had signs of anxiety and depression and those are mostly gone. He did start weekly therapy too at the same time - that is helping as well. This medication is not going to give you amazing results - stimulants work best and should be the first line treatment. We tried those and my son can’t do stimulants. So far this plus guanfacine is what we have landed on for now after trying for 2 years… it’s helping enough for now.

[Hidden in reply to amewhit]

For my son the same- stimulants caused so severe side effects and rebound - 8 months of suffering for my son when he was on stimulants.

Never looked back since swapping to Atomoxetine but as you say it is not perfect. May I ask why you also added Guanfacine and at what dose? In the UK paediatric psychiatrist seem over cautious and don’t want to mix meds, they prefer mono therapy…

[amewhit in reply to Hidden]

Yes same, we tried them for an entire school year! 9 months straight, concerta first for a while, then vyvanse then adderall (that one was the WORST). Concerta worked the best, but the afternoons were bad. We should have tried adding guanfacine along with the stimulants (very common in the US and people say that combo is really good), but we didn't have a great psychiatrist at the time. We removed all meds last summer, then found a new psychiatrist and started guanfacine when he started 6th grade. The guanfacine DID help with focus and also with impulsivity and aggressive behavior. It was the first thing that helped, and his teachers noticed he was calmer in class. My son even commented, mom I like this medicine it helps me focus. We did that for a while, but we felt we needed something more. So we added Strattera. This combo is working pretty well. They do different things. Guanfacine stimulates the frontal cortex, and strattera affects norepinephrine. So here in the US, it is common to mix medications to acheive optimal results. I wish stimulants worked for him, but I suspect because he most likely has anxiety/depression/pretty severe emotional dysregulation it just aggravated those things. His focus is still all over the place. But it is easier to 'bring him back' to focusing and he is less angry/aggressive. This is a very good article from ADDitude which is a great resource!! I love all of their podcasts.

additudemag.com/medication/...