Expert: Dr Billy Levin - 9/4/2010

Question
QUESTION: you previously answered a question of mine regarding clonidine
for add. i asked my doctor for adderall and he told me to try
strattera instead. i don,t know why he wouldn't prescribe
adderall. is strattera really effective in treating add?

ANSWER: It is difficult to contradict you doctor as I have not personally examined you. However in my practice dedicated to ADHDS I never ever  start with Strattera for many valid reasons. Firstly it is NOT as effective as the stimulants. It can take up to 8 weeks to get to an optimal dose. Only an optimal dose works. With Ritalin an optimal dose can be achieved within 10 days. The only real advantage in favour of Strattera is it works for 24 hours where as Ritalin taken three times a day gives a 12 hour cover. This is occasionally of some value. I may switch to Strattera later if needed or use both together. Is your doctor using any method to monitor your progress to an optimal dose?

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

QUESTION: i started at 18mg 1 x daily for 2 days,then 18mg 2x daily for
2 days,stay on 18mg2 x daily for two weeks and then return for
evaluation.
he is opposed to prescribing stimulants for adults. i know the
strattera is not effective. thanks for your input.  

Answer
I am afraid nothing makes any sense. Changing a dose of
Strattera after 2 days in unbelievable to say the least. The dose should be  based on body weight. As it may take anyhing up to 4 weeks to start working why the need to reassess after 2 weeks. I cannot understand why he is reluctant to use stimulants in adults. If nothing is working your options are firstly to talk to him or if no improvement seek a second opinion. If you are an adult and weigh 60kg the starting dose (0.5mg per kg) woud be 30mg.(36mmg is thus OK). If you weigh more this dose would be ineffective.   
0,5mg /kg
1,2mg/kg
1.4mg/kg
1.8mg /kg
These are the doses based on weight. If the small dose does not work the next level is prescribed and so on. I hope this helps.