Expert: Dr Billy Levin - 10/24/2008

Question
QUESTION: Dear Dr Levin,

A few weeks ago I ended up in the hospital for a few days because my heart was beating quite fast (> 120 beats a minute)and was becoming stressed. The cardiologists said it was the strattera and took me off of it. My heart still gets up to/ over 100 with light activity (a couple of flights of stairs). Do you know of information or resources about how this could have affected my heart and if there are tests I should get? While I was in hospital they did a stress test and a MIBI (sp?)and said they were good.  I have read that some people do not metabolize strattera well - what is the test for this? I will be seeing a cardiologist and a psychiatrist soon and I want to understand enough to ask relevant questions. I was on 300 mg of wellbutran SL and 40 ml of strattera I chose to also off of the strattera two weeks ago. Are there other non stimulant medications for ADD?  

Thank you.

ANSWER: Firstly a search on the Internet would give you more than enough info on Strattera. Strattera is a`non stimulant so it is`most unlikely to cause tachycardia on its`own. The Wellbutrin might have also played a`role  if you are sensitive to these medications. The dose of Strattera (40mg) is a very small dose for the average adult so it is not very likely on its own to cause the problem. Are you on any other medication or do you drink anything with caffeine. Did you stop the Strattera`or did the cardiologist? Why was your Psychiatrist not first consulted? If you are going to see the psychiatrist he will know what to ask you and you do not need to know what to ask him. There are other non stimulants simulants but non as affective as stimulants or Strattera. Most important  how long were you on Strattera when this episode occurred?  There is medication to reduce the tendency to tachycardia  if Strattera is needed. Beta Blockers may be successful. If the cardiologist and Psychiatrist get together they should be able to solve you problem and not need to stop the treatment for your ADD. To help I would need much more information. AS you can see I have asked more questions than given answers.


---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Levan,

I'm well past the  6 1/2 lives of either of these drugs, and my pulse still can go up to 100 when I'm sitting around. Is there any way that either wellbutran or strattera cause any long lasting effects?  I have noticed that Lilly does have  warnings, but only about preexisting heart conditions -which I did not have.
Yes, I was sipping on iced tea ( + to about 30 mg of caffeine) when I was sick - I don't think it started the event, but it might have made it worse - I have drunk it several times while on this medication, and was not bothered.
The cardiologists took me off all meds while I was in the hospital, then an on site psychiatrist gave me a prescription for the wellbutran XL (my psychiatrist had just retired, so my GP was perscribing my meds -and is now  refering me to a psychiatrist who specializes in ADD).
I chose to stop taking the wellbutran as well because  both meds came with info saying to tell your Dr if your heart races - and it still 120 a couple of times after I was home -and because my Dr had added the strattera to it, because it wasn't doing much on its own (but no side effects either).
I took Strattera for about six weeks, but  developed constipation, I went off until this resolved (5 weeks), and then tried it again for another 6 weeks, and got the same, plus sweating, dry mouth, nausea, vomiting, numb finger tips and almost fainting, and had just made an appointment with my GP to discuss going off of the wellbutran when I got sick.
They also found that my kidneys were stressed, but came back up to almost normal within two weeks of going off the meds.

Thanks  

Answer
Strattera and Wellbutrin do not have any long term serious side effects. Your cardiologist stopped some of your treatment and you the rest. Why has the doctor who is `treating your ADHD  not been consulted? ADHD/ADD is not a `part time condition and it is certainly    not in your interest to stop and start treatment for any reason. If you do have serious cardiac condition the cardiologist should discuss it with your Psychiatrist. But you should not change treatment on your own. Tachycardia might just be anxiety and not a cardiac condition. Let the experts  get their heads together for your benefit.