Strattera and Ritalin are prescription medications used to treat attention deficit hyperactivity disorder (ADHD). Both are designed to help decrease hyperactivity and increase focus. Ritalin is also used to treat the sleep disorder narcolepsy.
Although they’re both prescribed for ADHD, these two drugs are very different. Strattera’s active ingredient is atomexetine hydrochloride. It’s a selective norepinephrine reuptake inhibitor that affects the neurotransmitters in the brain. It does not lead to dependence and is not likely to be abused.
Ritalin’s active ingredient is methylphenidate hydrochloride. This is a central nervous system stimulant, which prevents the reuptake of both norepinephrine and dopamine in the brain, which increases their duration of action. Ritalin is a federally controlled substance because it can be habit-forming and is sometimes abused.
Strattera and Ritalin are available in a variety of doses. It’s not unusual to start out with a low dose and gradually increase it until symptoms improve. Dosages may have to be adjusted from time to time.
Both medications should be taken whole and never chewed or crushed.
Strattera is available in 10, 18, 25, 40, 60, 80, and 100 mg capsules. It can be prescribed for use either once or twice a day. While it can be taken with or without food, it should be taken at the same time each day.
Strattera is rapidly absorbed, and maximum concentration occurs one to two hours after taking it. Children’s doses are based on body weight, and Strattera is approved to be given to children age six and older.
Strattera generally takes two to four weeks to become fully effective, but you may feel some changes during the first few weeks. A small percentage of people metabolize the drug very slowly, and may need to be adjusted to a smaller dose. Strattera may be less convenient for children, especially if they have difficulty swallowing capsules or remembering to take multiple doses.
Some drugs are processed in the body through the same pathway as Strattera, so the combination can increase the blood level and effect of Strattera. These include drugs like paroxetine, fluoxetine and quinidine. The dose of Strattera may need to be decreased.
Drugs that should not be taken with Strattera include MAO inhibitors (some antidepressants) and pimozide.
The dose of Strattera or the following drugs combined with Strattera may need to be adjusted:
- inhaled drugs for asthma (like albuterol)
- other stimulants
- dofetilide (Tikosyn, used to treat heart arrhythmias)
- weight loss drugs
- over-the-counter decongestants
Tell your doctor about all drugs you are taking, including over-the-counter drugs.
Ritalin is available in 5, 10, and 20 mg tablets (in the fast-release form) and is available in generic form also. This form is taken two or three times a day, about 30 to 45 minutes before a meal. Ritalin can interfere with sleep if taken too close to bedtime.
Ritalin is also available as Ritalin LA, a capsule that has an extended 24-hour release. You could be switched to Ritalin LA after your doctor first gets you started on the fast-release product and decides to adjust your dosing pattern. Ritalin LA is available in 10mg, 20mg, 30mg and 40 mg strengths.
It may take up to four weeks for ADHD symptoms to improve under Ritalin. Ritalin is approved for children aged six and older, and children usually start out taking 5 mg twice a day. Children should not take more than 60 mg a day. Adults usually take 20 to 30 mg a day. Some may only need 10 to 15 mg, but others may need up to 60 mg per day.
Ritalin also interacts with several drugs, and should not be taken with MAO inhibitors (antidepressants including phenelzine and tranylcypromine), or with alcohol.
Ritalin may increase the blood levels and effects of:
- drugs used to treat hypertension
- anticoagulants like warfarin
- anticonvulsants like phenytoin, primidone, and phenobarbital
- tricyclic antidepressants (amitriptyline and others)
- some drugs used to treat Parkinson’s disease
- some antipsychotic drugs
Drugs that may increase the blood levels and effects of Ritalin include:
- antipsychotic agents
- drugs for digestive illness, including ranitidine and omeprazole
For a complete list of Ritalin drug interactions, visit the NIH.
The Strattera label warns of the possibility of suicidal thoughts in children and teens who take the medication. That risk is higher early in treatment or when the dosage is adjusted. Contact your doctor immediately if your child takes Strattera and exhibits signs of depression, anxiety, or suicidal thinking.
Side effects of Strattera may include:
- upset stomach
- decreased appetite
Children can experience slowed growth. Taking Strattera also raises risk for liver damage and heart problems. Children should be screened for heart problems before starting Strattera. No studies have been conducted in children under the age of six.
People who take Ritalin can become dependent upon it, and have difficulty stopping taking it. You should not take Ritalin if you have a history of substance abuse. If you stop taking it suddenly, you may experience symptoms of withdrawal, which can lead to serious depression. These symptoms may worsen if you’re used to taking a high dose. It’s best to taper off the medication slowly, under a doctor’s care.
Ritalin also has potential to be abused by people who don’t have ADHD, when it’s used as a stimulant. You should never take Ritalin without a prescription.
Ritalin can cause heart problems, especially in people with preexisting cardiovascular issues. Some patients experience circulation problems in fingers and toes. New or worsening psychiatric symptoms have also been reported. Headache, upset stomach, and decreased appetite can also be side effects of Ritalin.
Ritalin can slow growth in children. Some doctors will advise discontinuing Ritalin for a few months each year, to help counteract this effect.
Allergic reaction is a possibility with any medication. Notify your doctor immediately if you experience rash, hives, or swelling. Tell your doctor about all the medications you’re taking. Other over-the-counter and prescription medications and supplements can interact with these medications.
Strattera and Ritalin can be stored at room temperature, but should be kept away from moisture, heat, and light. Both brand name drugs are available in generic form. Other brand names for methylphenidate hydrochloride include Concerta, Metadate, Methylin, and Quillivant.