Vyvanse vs. Strattera

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Vyvanse vs. Strattera comparison

Vyvanse (lisdexamfetamine) and Strattera (atomoxetine) are both used in attention deficit hyperactivity disorder (ADHD), and the both work by affecting levels of certain neurotransmitters. (Neurotransmitters are chemicals that allow nerves and nerve cells to communicate with one another).

Lisdexamfetamine is in the same drug class of central nervous system (CNS) stimulants as drugs like Adderall (amphetamine and dextroamphetamine) and Dexedrine (dextroamphetamine). Atomoxetine, however, is the first non-addictive ADHD treatment.

Both can cause nausea, sleep problems, and a number of other shared side effects, some more serious than others.

Because Vyvanse and Strattera are in different drug classes, however, their side effects differ somewhat. Strattera can cause sexual side effects, indigestion and possible allergic reaction, whereas Vyvanse can cause blurred vision , growth retardation in children and possibly seizures.

Still, the central difference from the standpoint of the person prescribed either Vyvanse or Strattera is Strattera has no addiction potential while the Vyvanse does.

Both lisdexamfetamine and atomoxetine interact with a number of drugs, but most importantly, neither should be taken within two weeks of your last dose of any drug classified as or containing a monoamine oxidase inhibitor (MAOI).

What are Vyvanse and Strattera?

Unlike traditional amphetamines and other central nervous system stimulants like Adderall and Dexedrine, Vyvanse is a prodrug. This means the chemical (lisdexamfetamine) contained in the pill isn't, itself, effective to treat the condition; it doesn't start working until the body breaks it down in the gut, where if forms dextroamphetamine. Dextroamphetamine is the sole active ingredient in Dexedrine and one part of the drug combination in Adderall, and therefore, lisdexamfetamine results in the same effects and reactions as other amphetamines by affecting the levels of the neurotransmitters norepinephrine and dopamine in the brain.

The slower breakdown and release makes Vyvanse less attractive to people who are addicted to or who abuse amphetamines. Lisdexamfetamine's particular chemistry means it takes longer and makes it more difficult to achieve the high they crave. This does not mean Vyvanse is not addictive or dangerous, however; it's still an amphetamine governed by the U.S. Controlled Substances Act because of its potential for abuse.

Strattera, on the other hand, has no potential for addiction or withdrawal symptoms - its central advantage.

Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI), which is an entirely different class than the CNS stimulants family to which the other ADHD medications belong. Strattera's non-addictive quality is a novel achievement in ADHD medical treatment. Even Ritalin (methylphenidate, also sold as Concerta), though not an amphetamine, is still a habit-forming stimulant that is psychologically addictive.

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What are the uses for Vyvanse and Strattera?

Doctors prescribe both Vyvanse and Strattera to treat ADHD in children and adults. Vyvanse also treats moderate to severe binge eating disorder.

What are the side effects of Vyvanse and Strattera?

Lisdexamfetamine and atomoxetine have a number of side effects in common. Some include a decrease in appetite, weight loss, nausea, vomiting, dizziness, and insomnia.

Atomoxetine can cause sinus headache, problems urinating, sexual problems, dry mouth and other issues. Less common, but more dangerous possible reactions to Strattera include serious allergic reaction and liver failure.

Lisdexamfetamine, like other amphetamines, can cause aggressive behavior, manic episodes and other psychological symptoms.

Cardiovascular problems like abnormal heart rhythm and high blood pressure have been reported by people taking Vyvanse as well as by people taking Strattera.

Priapism, that is, an erection lasting more than four hours, is a medical emergency that can be caused by either medication in rare cases.

This is not a complete list of side effects. If your doctor has prescribed you either of these drugs, ask them for more details.

Can I get addicted to Vyvanse and Strattera?

Strattera is not addictive.

Vyvanse, on the other hand, has a high potential for abuse, considering it's in the amphetamine family of drugs. Vyvanse tends to be less addictive than Adderall or Dexedrine because of its slow, measured absorption by the body compared with its fellow CNS stimulants.

Amphetamine addiction is marked by cravings, aggressive behavior, hostility, and even psychosis that may mimic schizophrenia.

What are the withdrawal symptoms of Vyvanse and Strattera?

Strattera, in addition to being non-addictive, also has no withdrawal symptoms. A doctor may choose to stop administering atomoxetine abruptly with no ill effects other than a possible mild relapse in the ADHD symptoms the medication was treating.

Withdrawal from Vyvanse, like withdrawal from any amphetamine, can be debilitating, especially after prolonged use. Withdrawal symptoms can include depression, fatigue, sleep disturbances, agitation, and intense cravings that can lead to relapse.

How should Vyvanse and Strattera be taken (dosage)?

Vyvanse

  • The recommended starting dose of Vyvanse for treating ADHD in adults is 30 mg. For children ages 6 to 12, the dosage is a pill containing 20 mg to 30 mg once daily in the morning. Doses may be increased by 10 mg to 20 mg per day at weekly intervals. The maximum dose is 70 mg daily.
  • The recommended dose for treating binge eating in adult is 50 to 70 mg daily. The starting dose is 30 mg per day and the dose is gradually increased by 20 mg at weekly intervals to reach the recommended daily dose.

Strattera

  • Strattera is taken in pill form once or twice daily. It may be taken with or without food. The capsules should never be broken and sprinkled on food. They must be taken whole.
  • The recommended starting dose for and children weighing more than 70 kg is 40 mg once daily.  The dose is increased after 3 days to 80 mg once daily or divided and given every 12 hours. The dose may be increased up to 100 mg daily to achieve the optimal response.
  • Children older than 6 and weighing 70 kg or less should receive 0.5 mg/kg once daily. The dose may be increased after 3 days to 1.2 mg/kg once daily or divided every 12 hours. The maximum daily dose shouldn't exceed 1.4 mg/kg or 100 mg, whichever is less.

Which drugs interact with Vyvanse and Strattera?

Never take MAOIs at the same time as either Vyvanse or Strattera. The risk is so great, you shouldn't even take atomoxetine or lisdexamfetamine within two weeks of your last dose of any drug classified as an MAOIs. Common MAOIs include phenelzine sulfate (Nardil) and tranylcypromine sulfate (Parnate), among others.

Fluoxetine (Prozac), paroxetine (Paxil) and some other medications can increase the likelihood of Strattera side effects by increasing concentrations of atomoxetine in the bloodstream.

Amphetamines, including Vyvanse, can raise blood pressure and may weaken or render ineffective medications used to control hypertension.

Furthermore, doctors should not administer norepinephrine to people taking Vyvanse, as it can cause serious cardiovascular problems.

Are Vyvanse and Strattera safe to take during pregnancy or while breastfeeding?

In experiments, animals given high doses of Strattera had babies with low birth weight and low survival rates. Furthermore, atomoxetine gets passed on in the milk animals use to feed their young, and therefore human mothers probably excrete the drug in their milk, too. No studies are available about the use of Strattera in pregnant or breastfeeding women, so a doctor who wishes to prescribe Strattera to a pregnant or nursing mother needs to weigh the benefits and risks of starting or continuing treatment with atomoxetine.

The recommendations regarding lisdexamfetamine during pregnancy and nursing are much clearer. Pregnant and breastfeeding mothers should not take this drug.

Amphetamines in general cause premature delivery, low birth weight, and withdrawal symptoms in newborns. Amphetamines are also passed on in breast milk, so either feed your infant with formula or don't take Vyvanse.

REFERENCE:

FDA Prescribing Information

Quick GuideADHD/ADD in Adults: Symptoms & Treatments in Pictures

ADHD/ADD in Adults: Symptoms & Treatments in Pictures

Summary

Vyvanse and Strattera are both used in the treatment of attention deficit hyperactivity disorder (ADHD). Vyvanse (lisdexamfetamine) however, is a prodrug form of amphetamine and therefore has some of the same addiction problems of other ADHD drugs. Strattera (atomoxetine) however, is a selective norepinephrine reuptake inhibitor (SNRI), which is not addictive - its main advantage. Read about dosage, side effects and pregnancy safety information.

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Reviewed on 2/23/2017
References
REFERENCE:

FDA Prescribing Information

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