Strattera/Cardiac Damage Sustained after stopping drug

What is the name of your state? Texas

I posted this originally under the wrong section. Here is the info, I hope someone can help.

Hello,
I will try to state the facts: There are 2 cases that have occured related to Strattera.

Case 1: 41 y/o healthy female RN with no history of cardiac abnormalities. Took Strattera for 9 days, discontinued bec. palpations, elevated heart rate. Noticed one week later while working at hospital heart rate of 150. Since that time my heart rate has stayed elevated. Resting heart rate 120-135. Complete cardiac workup: Conclusion: Normal, healthy, sinus tachycardia. . I have to take a beta blocker to slow my heart rate. My first incidence with this occured Jan. 2004 and my heart rate is still elevated.

I thought my case was isolated. But the same thing has occured to a 6 year old.

Case 2: Six year old healthy male child. Taken Strattera for 3 months. Playing Soccar noticed shortness of breath and chest pain. Parents took child for cardiac workup. He has been of Strattera for 4 weeks. His resting heart rate has not resumed to a normal rate. He wore a holter cardiac monitor for 24 hrs. Results, SVT with rate up to 212. Resting heart rate average 135-140. This child is still being followed for further cardiac testing.

On the insert on the clinical trials for Strattera it states that a very few % have had elevated sustained heart rates. It gave an average of 10 beats per minute elevated. What has happened on these 2 cases is well above the stated risks. I am wanting to find out if this has happened to others. Would it be best to seek Class Action Lawsuit? Or have these 2 cases go together as one case? I know there are probably others out there with similiar damages. How is the best way to approach this? I want the company to stop this drug, and do more research. The damages done so far to these 2 is unethical and immoral. This drug is targeted to children, what if this is happening to other children. It makes me sick that children will have damaged hearts!

I have never been one before to want to seek medical damages, but I cannot let this go. I work in the medical field, but I want the manufacturer to take responsibility for this damage.

How do I go about this? I really do appreciate your help.
Thank you,

This may be a partial answer to your problem, however I have a concern re Rx Strattera because it's use for ADHD may cause it's offlabel use and/or use in patients misDx with ADHD who actually have Asperger's and who tend to have atypical reactions to Rx, or may misreport their reactions.

Obviously documented tachycardia is an objective clinical finding, however it may also be the result of a reaction you would have to any NE Rx if you cannot tolerate it. Have you taken anyother Rx which target NE? Was the Rx prescribed by PCP or a psychiatrist? At what point did you develop tachycardia during your trial? Were you taking any other RX, OTC and/or supplements? What was your BP during this time? Answers to these quesitons may help determine what path to take.

Psychiatric News December 6, 2002
Volume 37 Number 23 p. 41
American Psychiatric Association

• Researchers at Eli Lilly have produced further evidence that their new ADHD medication, atomoxetine (Strattera), works through increasing extracellular levels of norepinephrine (NE). In a study in rats, the medication was shown to have very high affinity for norepinephrine transporters, less affinity for serotonin transporters, and relatively low affinity for dopamine transporters. The high affinity for the NE transporter blocks reuptake of NE, increasing availability of the neurotransmitter in synapses in the prefrontal cortex of the rats.

( Neuropsychopharmacology 2002; 27:699-711[Medline])

Researchers at Eli Lilly have produced further evidence that their new ADHD medication, atomoxetine (Strattera), works through increasing extracellular levels of norepinephrine (NE). In a study in rats, the medication was shown to have very high affinity for norepinephrine transporters, less affinity for serotonin transporters, and relatively low affinity for dopamine transporters. The high affinity for the NE transporter blocks reuptake of NE, increasing availability of the neurotransmitter in synapses in the prefrontal cortex of the rats.

Click to expand...

Do you have any idea what any of that means, especially in correlation to the OP's situation?

glitterdoll
I believe the effects of taking Strattera show that you have a hypersensitivity to the drug. There was no way for you (or the 6 year-old child) to know of the hypersensitivity until you took the medication. Like all chemicals or chemical compounds, Strattera has a half-life and after the medication has completely left your system, the tachycardia should subside and resolve. I'm a little concerned about the aggressive treatment provided, the beta-blockers, because beta-blockers are not without their own side-effects and adverse reactions. You will have to trust your MD on his or her judgment in this situation.

It may be that taking Strattera was actually a good thing for you. You may have detected an underlying tendency or pathophysiology for cardiac distress and having this knowledge may prevent you from suffering an acute coronary event in the future. Stay on top of your cardiac health.

If you take herbal remedies or herbal supplements, that may have triggered the response to the Strattera. Be sure you have informed your physician of any herbal treatments (including herbal teas) that you were consuming when you took Strattera.

If you have been taking any MAO inhibitors (Nardil, Parnate, Marplan, and other antidepressants), that medication could have interacted with Strattera.

You have to understand that medications like Strattera interfere with the normal functioning of the brain and these medications work without anyone's really understanding how they work. Any time you mess with the way your brain works, you are taking a chance at the outcome. That's why nonmedical and nonpharmacological behavior modification is safer and just as productive as taking a pill. Behavior modification takes more effort and we Americans prefer to have the instant gratification and changes wrought from medication rather put out the effort to control our own behaviors. We also prefer to teach our children in manners that are not in sync with the way children learn; therefore, we have children on medications like Strattera so they can make bubbles to learn to construct sentences and make sets of zero and sets of 1 and 1 instead of learning subject and verb=sentence and 1+1=2. Besides, the drug companies make billions of dollars each year and who would want to stop that?

Stay on top of your cardiac health and be glad that you found out that your heart reacts to trigger medications and therefore probably reacts to trigger situations. You may just have saved yourself from a serious MI at any early age; being female with a potential heart problem in your future, you have no idea how lucky you are to have this opportunity to improve your cardiac health and awareness.

Best wishes,
EC

When I gave my advice, I kept it brief because this is a legal forum and OP claimed to be an RN and thus should have understood the clinical implications of hypersitivity to any Rx and or ADR. I also expressed my concern re any Rx but in this case Strattera being used where it is not appropriate one of the reasons why advertising Rx on the TV leads to inappropriate usage. I also asked some questions for specific reasons.

While an ADR is distressing, as EC said, it is far better to know know your hypersensitivity than to find out too late sometime in the future. This is not a case for a lawsuit but you do need to learn about your conditions and work with appropriate physicians, in your case a psychiatrist. Strattera, while not a stimmulant does target NE and thus like tricyclic Antidepressant Rx also known for their cardiac effect, expecially in cases where there is brain injury of any sort, which will limit Rx avalable for you to take. You will need appropriate referrals and to follow you health, for example, if you have Asthma, your reaction will limit what Rx you can take and in general your doctors will want to follow the general precautions for elderly or chronic illness or known sensitivity, "start low and go slow". I would also suggest keeping a bp log checking for Orthostasis and noting any environmental triggers, you may need a referal to an electrophysiologist, again as EC said beta blockers have their problems as well and there may be behavioral and nonmedical lifestyle changes which can improve your health.

Researchers at Eli Lilly have produced further evidence that their new ADHD medication, atomoxetine (Strattera), works through increasing extracellular levels of norepinephrine (NE). In a study in rats, the medication was shown to have very high affinity for norepinephrine transporters, less affinity for serotonin transporters, and relatively low affinity for dopamine transporters. The high affinity for the NE transporter blocks reuptake of NE, increasing availability of the neurotransmitter in synapses in the prefrontal cortex of the rats.

Click to expand...

What happens to this norepinephrine in the extracellur tissues? What happens when this saved and stored norepinephrine reenters the system? maybe tachycardia? maybe sustained tachycardia? How is Eli Lillly sure that the spared and saved norepinephrine goes to the area of the brain where it is needed and not to the area of the brain that controls heart rate? Norepinephrine is chemically and pharmacologically like epinephrine, which raises the heart rate. Norepinephrine constricts vessels (vasoconstrictor) so the cardiac output receives little effect. Does that make it a safe drug? I don't know, sounds kind of iffy to me.

I believe the OP should report her reaction to Strattera to Eli Lily and to the FDA. Statistics are the motivating force behind reviews of medications for safety.

I still don't think a lawsuit is indicated. I do think the reaction should be brought to the attention of Eli Lilly and the FDA.

EC

Thank you for your comments. I haven't been able to read them until today. I have had to work the last 2 days/ 12 hr shifts.

To answer some of the comments; Quote:

"Obviously documented tachycardia is an objective clinical finding, however it may also be the result of a reaction you would have to any NE Rx if you cannot tolerate it. Have you taken anyother Rx which target NE? Was the Rx prescribed by PCP or a psychiatrist? At what point did you develop tachycardia during your trial? Were you taking any other RX, OTC and/or supplements? What was your BP during this time? Answers to these quesitons may help determine what path to take."

At the time I took the Strattera I was not on any other medication or over the counter medication. My blood pressure before taking strattera has always run low, usually 110/60. I had not been taking any medication before taking Strattera. I have been healthy only taking multivitamins. I wasn't and do not take herbal suppliments. There wasn't any other combination of medications to enhance or contribute to my reaction to the medication.

The medication was prescribed by a general practioner for adult ADD. I developed tachycardia during the second day of taking the medication. I continued to take it for 9 days to see if I could tolerate it.

Quote:
Researchers at Eli Lilly have produced further evidence that their new ADHD medication, atomoxetine (Strattera), works through increasing extracellular levels of norepinephrine (NE). In a study in rats, the medication was shown to have very high affinity for norepinephrine transporters, less affinity for serotonin transporters, and relatively low affinity for dopamine transporters. The high affinity for the NE transporter blocks reuptake of NE, increasing availability of the neurotransmitter in synapses in the prefrontal cortex of the rats.
Quote:
What happens to this norepinephrine in the extracellur tissues? What happens when this saved and stored norepinephrine reenters the system? maybe tachycardia? maybe sustained tachycardia? How is Eli Lillly sure that the spared and saved norepinephrine goes to the area of the brain where it is needed and not to the area of the brain that controls heart rate? Norepinephrine is chemically and pharmacologically like epinephrine, which raises the heart rate. Norepinephrine constricts vessels (vasoconstrictor) so the cardiac output receives little effect. Does that make it a safe drug? I don't know, sounds kind of iffy to me.

I agree with you. I understand the chemical pharmacology of the medication. It is for that reason that I feel there is something wrong with this medication. It should have not made the sustained cardiac elevation. I feel there is something else that may have occured. You had two normal healthy individuals who have had very similiar occurances. I didn't have anything that would make me "Sensitive" to the medication, such as asthma, ect.

Your reaction is a known reaction to Straterra and as EC said should be reported to the FDA by your doctor and if they haven't or won't, then you report it along with any documentation.
http://www.fda.gov/opacom/backgrounders/problem.html

If you are a poor metabolizer/can't tolerate Straterra then you will, as you did have an adverse reaction, rather quickly, which should have been reported immediately and the Rx DC. This is not the fault of the doctor or the medication, but your individual reaction, however caution needs to be used with this or any Rx, beyond the fact that any lisensed physician can Rx. That is why I asked the questions I asked, please see a psychiatrist for proper Dx/Rx. Did the same doctor Rx the bata blocker? Run the other tests? "Laboratory tests are available to identify CYP2D6 PMs.[/U] The blood levels in PMs are similar to those attained by taking strong inhibitors of CYP2D6." Being a PM could haveexacerbated the other effects of Straterra re NE.

In light that you were not taking anyother Rx. OTC and/or supplements, this indicates you most likely would also have reactions to ones affecting NE as well and is a good thing to have discovered, however you may have increased the problem by continuing to take it the full length of the trial. With your history of low BP, which is usually considered healthy, has it's own considerations insofar as Rx. I won't go into it here. Please log your bp/hr for orthostasis at least 3 times a day, this will be a good documentation for future use and reccommended anyway.

Here is some specific information re Strattera and Tachycardia from Dr. Koop's site http://www.drkoop.com/druglibrary/93/105_3.html :
PRECAUTIONS
General Effects on blood pressure and heart rate
— STRATTERA should be used with caution in patients with hypertension, tachycardia, or cardiovascular or cerebrovascular disease because it can increase blood pressure and heart rate. Pulse and blood pressure should be measured at baseline, following STRATTERA dose increases, and periodically while on therapy. In pediatric placebo-controlled trials, STRATTERA-treated subjects experienced a mean increase in heart rate of about 6 beats/ minute compared with placebo subjects. At the final study visit before drug discontinuation, 3.6% (12/ 335) of STRATTERA-treated subjects had heart rate increases of at least 25 beats/ minute and a heart rate of at least 110 beats/ minute, compared with 0.5% (1/ 204) of placebo subjects. No pediatric subject had a heart rate increase of at least 25 beats/ minute and a heart rate of at least 110 beats/ minute on more than one occasion.

Tachycardia was identified as an adverse event for 1.5% (5/ 340) of these pediatric subjects compared with 0.5% (1/ 207) of placebo subjects. The mean heart rate increase in extensive metabolizer (EM) patients was 6.7 beats/ minute, and in poor metabolizer (PM) patients 10.4 beats/ minute. STRATTERA-treated pediatric subjects experienced mean increases of about 1.5 mm Hg in systolic and diastolic blood pressures compared with placebo. At the final study visit before drug discontinuation, 6.8% (22/ 324) of STRATTERA-treated pediatric subjects had high systolic blood pressure measurements compared with 3.0% (6/ 197) of placebo subjects. High systolic blood pressures were measured on 2 or more occasions in 8.6% (28/ 324) of STRATTERA-treated subjects and 3.6% (7/ 197) of placebo subjects.

At the final study visit before drug discontinuation, 2.8% (9/ 326) of STRATTERA-treated pediatric subjects had high diastolic blood pressure measurements compared with 0.5% (1/ 200) of placebo subjects. High diastolic blood pressures were measured on 2 or more occasions in 5.2% (17/ 326) of STRATTERA-treated subjects and 1.5% (3/ 200) of placebo subjects. (High systolic and diastolic blood pressure measurements were defined as those exceeding the 95 th percentile, stratified by age, gender, and height percentile -National High Blood Pressure Education Working Group on Hypertension Control in Children and Adolescents.)

In adult placebo-controlled trials, STRATTERA-treated subjects experienced a mean increase in heart rate of 5 beats/ minute compared with placebo subjects. Tachycardia was identified as an adverse event for 3% (8/ 269) of these adult atomoxetine subjects compared with 0.8% (2/ 263) of placebo subjects.

STRATTERA-treated adult subjects experienced mean increases in systolic (about 3 mm Hg) and diastolic (about 1 mm Hg) blood pressures compared with placebo. At the final study visit before drug discontinuation, 1.9% (5/ 258) of STRATTERA-treated adult subjects had systolic blood pressure measurements 150 mm Hg compared with 1.2% (3/ 256) of placebo subjects. At the final study visit before drug discontinuation, 0.8% (2/ 257) of STRATTERA-treated adult subjects had diastolic blood pressure measurements 100 mm Hg compared with 0.4% (1/ 257) of placebo subjects. No adult subject had a high systolic or diastolic blood pressure detected on more than one occasion.

Orthostatic hypotension has been reported in subjects taking STRATTERA. In short-term, child-and adolescent-controlled trials, 1.8% (6/ 340) of STRATTERA-treated subjects experienced symptoms of postural hypotension compared with 0.5% (1/ 207) of placebo-treated subjects. STRATTERA should be used with caution in any condition that may predispose patients to hypotension. Effects on urine outflow from the bladder — In adult ADHD controlled trials, the rates of urinary retention (3%, 7/ 269) and urinary hesitation (3%, 7/ 269) were increased among atomoxetine subjects compared with placebo subjects (0%, 0/ 263). Two adult atomoxetine subjects and no placebo subjects discontinued from controlled clinical trials because of urinary retention. A complaint of urinary retention or urinary hesitancy should be considered potentially
related to atomoxetine.

Information for Patients

Patients should read Information for Patients before starting therapy with STRATTERA and when the prescription is renewed. Patients should consult a physician if they are taking or plan to take any prescription or over-the-counter medicines, dietary supplements, or herbal remedies. Patients should consult a physician if they are nursing, pregnant, or thinking of becoming pregnant while taking STRATTERA. Patients may take STRATTERA with or without food.

If patients miss a dose, they should take it as soon as possible, but should not take more than the prescribed total daily amount of STRATTERA in any 24-hour period. Patients should use caution when driving a car or operating hazardous machinery until they are reasonably certain that their performance is not affected by atomoxetine.

Laboratory Tests Routine laboratory tests are not required.
CYP2D6 metabolism — Poor metabolizers (PMs) of CYP2D6 have a 10-fold higher AUC and a 5-fold higher peak concentration to a given dose of STRATTERA compared with extensive metabolizers (EMs). Approximately 7% of a Caucasian population are PMs. Laboratory tests are available to identify CYP2D6 PMs. The blood levels in PMs are similar to those attained by taking strong inhibitors of CYP2D6. The higher blood levels in PMs lead to a higher rate of some adverse effects of STRATTERA (see ADVERSE REACTIONS).

Drug-Drug Interactions Albuterol — STRATTERA should be administered with caution to patients being treated with
systemically-administered (oral or intravenous) albuterol (or other beta2 agonists) because the action of albuterol on the cardiovascular system can be potentiated.

CYP2D6 inhibitors — Atomoxetine is primarily metabolized by the CYP2D6 pathway to 4-hydroxyatomoxetine. In EMs, selective inhibitors of CYP2D6 increase atomoxetine steady-state plasma concentrations to exposures similar to those observed in PMs. Dosage adjustment of STRATTERA may be necessary when coadministered with CYP2D6 inhibitors, e. g., paroxetine, fluoxetine, and quinidine (see DOSAGE AND ADMINISTRATION). In EM individuals treated with paroxetine or fluoxetine, the AUC of atomoxetine is approximately 6-to 8-fold and Css, max is about 3-to 4-fold greater than atomoxetine alone. In vitro studies suggest that coadministration of cytochrome P450 inhibitors to PMs will not increase the plasma concentrations of atomoxetine. Monoamine oxidase inhibitors — See CONTRAINDICATIONS.

"Your reaction is a known reaction to Straterra and as EC said should be reported to the FDA by your doctor and if they haven't or won't, then you report it along with any documentation.

Yes, I will report it.


"If you are a poor metabolizer/can't tolerate Straterra then you will, as you did have an adverse reaction, rather quickly, which should have been reported immediately and the Rx DC. This is not the fault of the doctor or the medication, but your individual reaction, however caution needs to be used with this or any Rx, beyond the fact that any lisensed physician can Rx. That is why I asked the questions I asked, please see a psychiatrist for proper Dx/Rx. Did the same doctor Rx the bata blocker? Run the other tests? "Laboratory tests are available to identify CYP2D6 PMs.[/U] The blood levels in PMs are similar to those attained by taking strong inhibitors of CYP2D6." Being a PM could haveexacerbated the other effects of Straterra re NE."

I had read information concerning "Poor metabolizer" and really didn't think this was the case. I may have the blood test to find out just to be sure.

"In light that you were not taking anyother Rx. OTC and/or supplements, this indicates you most likely would also have reactions to ones affecting NE as well and is a good thing to have discovered, however you may have increased the problem by continuing to take it the full length of the trial. With your history of low BP, which is usually considered healthy, has it's own considerations insofar as Rx. I won't go into it here. Please log your bp/hr for orthostasis at least 3 times a day, this will be a good documentation for future use and reccommended anyway."

I have been monitoring my blood pressure. It is lower, but it hasn't been a problem as far as "Orthostatic hypotension". Thanks for recommending to check it!

"Here is some specific information re Strattera and Tachycardia from Dr. Koop's site http://www.drkoop.com/druglibrary/93/105_3.html :
PRECAUTIONS
General Effects on blood pressure and heart rate
— STRATTERA should be used with caution in patients with hypertension, tachycardia, or cardiovascular or cerebrovascular disease because it can increase blood pressure and heart rate. Pulse and blood pressure should be measured at baseline, following STRATTERA dose increases, and periodically while on therapy. In pediatric placebo-controlled trials, STRATTERA-treated subjects experienced a mean increase in heart rate of about 6 beats/ minute compared with placebo subjects. At the final study visit before drug discontinuation, 3.6% (12/ 335) of STRATTERA-treated subjects had heart rate increases of at least 25 beats/ minute and a heart rate of at least 110 beats/ minute, compared with 0.5% (1/ 204) of placebo subjects. No pediatric subject had a heart rate increase of at least 25 beats/ minute and a heart rate of at least 110 beats/ minute on more than one occasion.

Tachycardia was identified as an adverse event for 1.5% (5/ 340) of these pediatric subjects compared with 0.5% (1/ 207) of placebo subjects. The mean heart rate increase in extensive metabolizer (EM) patients was 6.7 beats/ minute, and in poor metabolizer (PM) patients 10.4 beats/ minute. STRATTERA-treated pediatric subjects experienced mean increases of about 1.5 mm Hg in systolic and diastolic blood pressures compared with placebo. At the final study visit before drug discontinuation, 6.8% (22/ 324) of STRATTERA-treated pediatric subjects had high systolic blood pressure measurements compared with 3.0% (6/ 197) of placebo subjects. High systolic blood pressures were measured on 2 or more occasions in 8.6% (28/ 324) of STRATTERA-treated subjects and 3.6% (7/ 197) of placebo subjects.

At the final study visit before drug discontinuation, 2.8% (9/ 326) of STRATTERA-treated pediatric subjects had high diastolic blood pressure measurements compared with 0.5% (1/ 200) of placebo subjects. High diastolic blood pressures were measured on 2 or more occasions in 5.2% (17/ 326) of STRATTERA-treated subjects and 1.5% (3/ 200) of placebo subjects. (High systolic and diastolic blood pressure measurements were defined as those exceeding the 95 th percentile, stratified by age, gender, and height percentile -National High Blood Pressure Education Working Group on Hypertension Control in Children and Adolescents.)

In adult placebo-controlled trials, STRATTERA-treated subjects experienced a mean increase in heart rate of 5 beats/ minute compared with placebo subjects. Tachycardia was identified as an adverse event for 3% (8/ 269) of these adult atomoxetine subjects compared with 0.8% (2/ 263) of placebo subjects.

STRATTERA-treated adult subjects experienced mean increases in systolic (about 3 mm Hg) and diastolic (about 1 mm Hg) blood pressures compared with placebo. At the final study visit before drug discontinuation, 1.9% (5/ 258) of STRATTERA-treated adult subjects had systolic blood pressure measurements 150 mm Hg compared with 1.2% (3/ 256) of placebo subjects. At the final study visit before drug discontinuation, 0.8% (2/ 257) of STRATTERA-treated adult subjects had diastolic blood pressure measurements 100 mm Hg compared with 0.4% (1/ 257) of placebo subjects. No adult subject had a high systolic or diastolic blood pressure detected on more than one occasion."



Before I ever took any of the medicine, I read the complete insert. I had read all of the information concerning the clinical trials. I was aware of increase in heart rate before discontinuation of the trial. The trial never stated when the medication was discontinued that the elevation of the heart rate continued. That is what I am most concerned about. I wouldn't be worried if my heart was fast while I took the medicine, I understand why. I don't understand why it doesn't return to a base rate before the medication was ever started.
I went and had a complete cardiac evaluation. The cardiologist prescribed the betablocker for the tachycardia. This was done after extensive testing. The conclusion was my heart is healthy but tachycardiac. It has never been like this in my life. [/U]

"Laboratory Tests Routine laboratory tests are not required.
CYP2D6 metabolism — Poor metabolizers (PMs) of CYP2D6 have a 10-fold higher AUC and a 5-fold higher peak concentration to a given dose of STRATTERA compared with extensive metabolizers (EMs). Approximately 7% of a Caucasian population are PMs. Laboratory tests are available to identify CYP2D6 PMs. The blood levels in PMs are similar to those attained by taking strong inhibitors of CYP2D6. The higher blood levels in PMs lead to a higher rate of some adverse effects of STRATTERA (see ADVERSE REACTIONS)."

Even if a person is a Poor Metabolizer shouldn't their heart rate return to normal when the medication is out of their system?


"CYP2D6 inhibitors — Atomoxetine is primarily metabolized by the CYP2D6 pathway to 4-hydroxyatomoxetine. In EMs, selective inhibitors of CYP2D6 increase atomoxetine steady-state plasma concentrations to exposures similar to those observed in PMs. Dosage adjustment of STRATTERA may be necessary when coadministered with CYP2D6 inhibitors, e. g., paroxetine, fluoxetine, and quinidine (see DOSAGE AND ADMINISTRATION). In EM individuals treated with paroxetine or fluoxetine, the AUC of atomoxetine is approximately 6-to 8-fold and Css, max is about 3-to 4-fold greater than atomoxetine alone. In vitro studies suggest that coadministration of cytochrome P450 inhibitors to PMs will not increase the plasma concentrations of atomoxetine. Monoamine oxidase inhibitors — See CONTRAINDICATIONS"

I understand this to read that Strattera along with other drugs may potentiate the effects, if you are a PM. But the above statement doesn't make me believe the effect is permament.

rmet4nzkx,
Thank you so much for your comments. It is very helpful. Let me know what you think.
Sincerely,
G.

The clinical trials with Strattera were done with rapid metabolizers (EM), in which case the half life is about 5 hours. In PM, who are about 7% of the population it could be 24 hours or longer so you would have had a considerable build up after 7-9 days, HOWEVER, about 35% of the population don't metabolize CYP2D6 at all, that is why you should have the test before taking the medication or any Rx with CYP2D6 pathways. It is frequently not done since most people when they have a reaction, complain or stop taking the drug. Tachycardia is very disconcerting to say the least, BTDT not fun at all. If you can't metabolize or metabolize Strattera very slowly, you are going to have tachycardia for some time, thus beta blockeds may be your only optionfor now. If you are a EM or PM and have either: Hepatic Insufficiency:
Atomoxetine exposure (AUC) is increased, compared with normal subjects, in EM subjects with moderate (Child-Pugh Class B) (2-fold increase) and severe (Child-Pugh Class C) (4-fold increase) hepatic insufficiency. Dosage adjustment is recommended for patients with moderate or severe hepatic insufficiency
OR
Renal Insufficiency
EM subjects with end stage renal disease had higher systemic exposure to atomoxetine than healthy subjects (about a 65% increase), but there was no difference when exposure was corrected for mg/kg dose. Atomoxetine HCl can therefore be administered to ADHD patients with end stage renal disease or lesser degrees of renal insufficiency using the normal dosing regimen.
This could also delay elimination of the Rx.

This is also where having low BP comes into play, since you have low BP you may have a form of dysautonomia and why I suggested the log for OH because there is a normal pattern when going from laying down to standing up, the absense of that pattern could contribute, since Strattera doesn't raise your BP as it normally does and why it is contraindicated for hypertention, having low bp instead, which will also contribute to tachycardia if your BP doesn't rise, could be a contraindication if you are a PM and/or don't metabolize it at all. Again, you will have to be careful in the future with any Rx, OTC and/or supplement, be especially careful of OTC with DM as an ingrediant or asthma Rx.
Get the test, that may answer many of your questions. Check with your cardiologist about the OH log and for referal to EP if needed. Let us know how the test comes out, hopefully your experience can be put to use and you will be very careful in the future with any Rx, etc. I have been in the same place and understand how frightening it can be. Take care.

rmet4nzkx said:

The clinical trials with Strattera were done with rapid metabolizers (EM), in which case the half life is about 5 hours. In PM, who are about 7% of the population it could be 24 hours or longer so you would have had a considerable build up after 7-9 days, HOWEVER, about 35% of the population don't metabolize CYP2D6 at all, that is why you should have the test before taking the medication or any Rx with CYP2D6 pathways. It is frequently not done since most people when they have a reaction, complain or stop taking the drug. Tachycardia is very disconcerting to say the least, BTDT not fun at all. If you can't metabolize or metabolize Strattera very slowly, you are going to have tachycardia for some time, thus beta blockeds may be your only optionfor now.

Click to expand...

I have previously taken albuterol without any difficulty. So, if I were a poor metabolizer, I would think that Albuteral would have affected me.


Don't you think after 10 months it would be out of my system? That is how long ago it has been since stopping the Strattera. This occured Jan. 2004. Since that time my cardiac rate has remained elevated.

I understand about the "short term" effects, and "half-life duration" of a drug. Even, for a person who doesn't metabolize certain enzymes.

Also, the six year old I know has been of the medication for a little over a month but his resting heart rate is still in the 140's. Maybe his rate will resolve. But his symptoms are just as mine were.

Thank you for your input on this. It is nice to share different thought on this. I was hoping that my reaction was isolated.

I may be more attuned to my body than others, at the time I noticed my heart racing I took my pulse. Normally, I would have ignored the symptom, and gone about my day. But... seeing that I was at a hospital, I was able to see what my pulse was with a pulse ox machine. My pulse at the time was 150.
The little boy only had his first symptom when playing a sport that required alot of cardiac exertion. Later when he wore a cardiac monitor for 24 hrs and played sports, they knew his heart rate was 212. His father is in the medical field and when he complained of shortness of breath when playing sports, his parents followed up with it the following working day.
So what I am saying is probably alot of other people are experiencing substantial cardiac elevation and not following up with it.
But while having an elevated cardiac rate while taking the drug may occur., When the medication is discontinued after a month, or 6 months, your heart SHOULD return to previous base rate!

So I am exasperated with what made this sustained elevated cardiac rate! The only expanation I have that cannot be proven at this point is taking the medication. But to me there is clearly cause and affect.

I'll let you know how the little boy does. I am hoping that he will be a "normal " little boy soon!