The clinical trials for drug approval showed effectivenes at 1.2 and 1.8mg/kg/day (split into 2 doses), or up to 1.5mg/kg/day (once a day). The package insert suggests 1.4mg/kg/day as the max dose for kids.
http://pi.lilly.com/us/strattera-pi.pdf#search='strattera%20 dose%20ADHD'
Your son would be 18kg (40lbs/2.2 lbs per kg) so the max dose of 1.4mg/kg/day would be the 25mg/day your doctor had your son on. I would further discuss the new dose with the doctor. There may be additional data that the doctor has, and although doctors are allowed to prescribe meds outside the approved ranges, I would want justification first.
HTH
my son is 7 yrs old and he only weighs 40 lbs,he has been on strattera and concerta.the strattera has 25 well today the psych upped his strattera to 40 is'nt that too much for a 40 lb child.i thought strattera was weight dosed? any info is appreciated.i took him to new dr today who wants him to try adderall 5 twice a day and slowly increase him. i always worry about a new med. but the school calling twice a week is getting to me also. thats a good sugestion about the breath,i've asked the dentist she said its medical,i've asked 2 drs,one said have him gargle with water,the other said have him brush his teeth at school,since the kids were making fun of him,and it is really bad at times but not all the time.i think they make a dry mouth mouthwash so i might see i'll try that.thanks again for the info..his dose should range between 20, and 32 mgs, or 1.2-1.8 mgs per kilo(2.2 lbs). Lower doses can cause modd issues, as can doses that are too high. So yes, 40 mgs for a 40lb child is WAY too much!
Also, Straterra HAS to be ramped up slowly from a low dose, it is not supposed to be started at the target dose, clinicla trials support this. The side effects are too prominent if it is not ramped.
As far as the bad breath, have him checked for Allergies, especially pollen allergies.
WE DID 36 AND IT MADE OUR SON WORSE. THIS DRUG IS SUPPOSE TO BE WEIGHT BASED. SOME GIVE AT NIGHT BEFORE BED. WE KNOW A 7 YEAROLD ASPERGERS BOY ON 40. So if your child weighs 50 pounds what would the recommended dose be? Since he is taking 40 mg every morning with breakfast?You would divide his weight by 2.2, then multiply that number by 1.2-1.8 to ge the correct dosage. For example 50 lbs, the dosage would be 26( really 25) mgs at 1.2 mgs per kilo, or 39(40mgs) at 1.8 mgs per kilo. It sounds like he is on the high end of the recommended dosage, the maximum recommended for his weight.Strattera should NEVER be started at 25 mgs. it should be started at 10 mgs and slowly, very slowly ramped up to the target dose. You won't see a the meds making a difference until the target dose has been reached for 6 weeks or so.
Straterra is dosed by weight, not symptom severity.
I now have something new to bring up to his doctor, because when he was started on Strattera he did 7 days of 25 mg, then right to 40 mg, and has been on that dose since.
I'm wondering if he did it the way he did since he failed with Adderal and with Concerta?
Michelle
My2Angels939839007.7528935185My son was started on Strattera a few weeks ago, he is 50 lbs. and he was started on 40 mg of Strattera.
Michelle
Does the dosage for the medication have anything to do with the severity of the symptoms? He started him on 25 mg for 7 days then increased it to 40mg. He said we won't see the full effects of this medication for up to 8 weeks. So far he is doing okay. He has calmed down, but he still has his moments. We noticed the biggest difference in him when we took him off the meds for one week because he simply hates taking them, when his teacher sent his work home he sent them back to her just scribbled on.. This week he is getting back on track, and aced his spelling test, and had a "great" note sent home. YIPPEE!!I really feel for you. Dealing with these issues is hard enough with a good medical team. It is near impossible when the doctors do not listen. I do not know if your doctor has worked with meds like guanfacine and clonidine, but my daughter's doctor added the guanfacine to the concerta to help with weight gain and because it helps with hyperactivity, impulsivity, calming. sleep issues and memory but not attention. I hope you find something that works.
Have you looked at dry mouth for the cause of the bad breath (the meds can dry the mouth)? Some other things to consider:
http://www.mayoclinic.com/health/bad-breath/DS00025/DSECTION =2
You might want to look for a different doctor. My daughter's doctor and I discuss all types of options, and he is very patient to make sure we are on the same page. It can take a while to get in as a new patient; and you can always cancel if the current doctor seems to get it together. What are the symtoms that the teacher is calling about? Are there any comorbidities? There are other options if the concerta/strattera combo does not work. We are working with concerta and guanfacine, as well as, behavior plan at school and home.he is seeing a psych who is giving him the meds. this dr just seems to want to give stronger meds. josh has been on 5 different meds since he was 5. i feel he has some medical problems but the drs won't listen to me,oh he's just skinny but he looks like a skeleton,even the kids at school make fun of him because he's so little,and he has terrible breath i tell the dentist she says oh its not dental its medical i tell the drs they tell me to have him gargle with water,yet i his mouth is so bad i can smell it from the back seat,and the kids also make fun of him about that. last week i got called twice,once from the teacher and once from the principal,the principal said he was running in class and jumping on the couch.and the letter the techer sent home said he has trouble remaining seated and focusing,and she said one day he is really good and the next day he is uncontrollable.i thought 40 mg is too much. i am so sick of drs.when he is on these and the teacher is calling me then he decreases his concerta and raises the strattera,i just don't know what to do.