Well, we are now trying Strattera after Concerta and Vyvanse failed.  My dd has alot of anxiety and the stimulants made it worse.   

I am counting on Strattera to work, but here's the problem.  She will be 7 next month and weighs 58 lbs.  According to the Strattera package insert, after the titration period her target dose would be 32mg (1.2 mg/kg).  So, I was hoping her pediatrician would give her two 18mg.  She could take one in the morning and one in the late afternoon.  I even mentioned this option to the nurse on the phone.  She put me on hold and checked, and came back and said no, that my dd should be started on the 18mg for 7 days, and then start taking the 25mg after 7 days.  My fear this is a sub-therapeutic dose and it is not going to work.  Does Strattera ever work at lower doses?

I wanted to try to up her dose from 20mg of Vyvanse to 30mg (which 30mg is the starting dose according to all the literature on the product) to see if it would work any better because of the rebound side effects in the evening, but he wouldn't do it.  That's when he wanted to switch to Strattera.  My dd was being treated by a psychiatrist, but if her medication didn't work, we had to wait until the next office visit to get a new medication which could be any where from 4 to 6 weeks away.  Her pediatrician will see my dd within one hour if I call him.  So, I really what her pediatrician to treat her if at all possible, but he is so conservative in his dosing.

How should I handle this?

My son is on strattera.  When on the concerta and vvanyse the rebound was horrible and eventually it did not seem that it was working.  He has been on strattera since the beginning of the summer.  We went throught the process of building it up in his systerm.  It was difficult at first, but it did start working.  He has now been diagnosed as ADHD/Bipolar and on a mood stablizer along with the STrattera and it seems fine.

It was my understanding that strattera has to build up in their systems and then will work continuously.

Good luck.

I would stick with the psychiatrist not the pediatrician. You are correct , especially with Strattera, if the dose is too low you will probably not see symptom relief and you will probably see side effects. Why not make the psychiatrist appointment while you ramp and see how it goes at 25. Then by the time you see the psychiatrist, you'll have some information on how it's going at that dose. Conservative can be good as you want to use the lowest dose possible with any med, but the reasons you're stating are why it's BEST to have a psychiatist for med management, they are just more experienced.

Good luck with the Strattera btw, my daughter has done very well using Strattera and a low dose of stim. VERY minimal anxiety issues.