Strattera vs Focalin for ADHD: what’s the difference?

Navigating the variety of available ADHD medications can be confusing when you’re trying to find the right one for you. Two such medications, Strattera (atomoxetine) and Focalin (dexmethylphenidate) are approved by the U.S. Food and Drug Administration (FDA) to treat ADHD symptoms, though they work differently in the body. In this guide, we compare Strattera vs Focalin to help you understand these ADHD drugs and make an informed decision about which, if any, is best for you.

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Strattera vs Focalin: are they the same type of medication?

Strattera and Focalin are both used to treat ADHD, but they’re not the same type of medication. Strattera is a selective norepinephrine reuptake inhibitor (SNRI), and Focalin is a central nervous system (CNS) stimulant. Each has a different mode of action in the body.

While Focalin and other CNS stimulants calm ADHD symptoms and are typically the first-line treatment for ADHD, they’re not always suitable for everyone. People with anxiety, cardiovascular, or substance abuse issues might have adverse reactions to stimulants. As an SNRI, Strattera is a non-stimulant ADHD medication that can also help treat other mental illnesses that occur with ADHD, like depression and anxiety.

If you’re considering medication to treat ADHD symptoms, talk to your doctor about ADHD treatment options. They can help you decide between stimulant vs non-stimulant medication and suggest an ADHD therapist if one is needed.

What is Strattera?

Strattera is an SNRI that helps regulate attention, focus, memory, and mood in people with ADHD. It’s been discontinued as a brand-name drug. Only generic atomoxetine is available.

How does Strattera work and what does it treat?

As an SNRI, Strattera increases norepinephrine and serotonin levels in your brain. Specifically, it prevents these neurotransmitters (nerve cell signalers) from being absorbed into glial cells and keeps them in the synaptic cleft, where they’re needed for effective brain cell communication.

Norepinephrine plays a key role in attentiveness, circulation, mood, and the sleep-wake cycle. Serotonin is involved in regulating mood, memory, happiness, body temperature, and hunger, among other things. 

Strattera can help improve your ADHD symptoms, like lack of attention, inability to listen or follow through on tasks, disorganization, forgetfulness, and distraction. Since SNRIs are primarily antidepressants, Strattera is an effective treatment for people with ADHD and depression or anxiety. 

Forms and doses of Strattera

Strattera is a capsule taken by mouth, with or without food. Doses start at 10 milligrams once a day, but you could take a maximum daily dosage of up to 100 milligrams depending on your needs. 

What’s the price of Strattera?

Without insurance, a 1-month supply (30 capsules) of Strattera can cost between $425 and $498, depending on the dosage and pharmacy. Prices are according to drugs.com with their discount card.

If you have health insurance, you’re likely responsible for your drug copay. Reach out to your insurance company to verify your out-of-pocket costs for Strattera. 

Strattera side effects

Strattera’s common side effects include:

• Constipation
• Dry mouth
• Nausea
• Decreased appetite
• Dizziness
• Trouble sleeping
• Sexual side effects
• Menstrual cramps
• Problems passing urine

People have experienced weight loss with Strattera. This can be due to its metabolic effects or occur secondary to side effects, like decreased appetite and nausea, which make you want to eat less. Strattera isn’t approved for weight loss and shouldn’t be used as a weight loss medication. If you’re concerned about losing weight with Strattera, talk to your healthcare provider about whether it’s right for you.

Serious side effects of Strattera include allergic reactions, suicidal thoughts or behaviors, and liver damage.

Precautions and warnings with Strattera

Strattera comes with some precautions and a boxed warning. If it turns out Strattera isn’t right for you, consult your healthcare provider before stopping the medication. Stopping suddenly can cause withdrawal symptoms. To prevent this, your healthcare provider will progressively lower your dose until it’s safe to stop.

Serotonin syndrome risk

In rare cases, individuals taking Strattera can develop serotonin syndrome. This is a potentially life-threatening condition caused by too much serotonin in the brain. Symptoms include mania, euphoria, and nausea, among others. 

While the risk of serotonin syndrome with Strattera is low, exercise caution when combining it with other medications that affect serotonin. Share all medications you take with your healthcare provider. They can help you evaluate the risks and benefits of Strattera and your potential for developing this syndrome.

Boxed warning for antidepressants 

All antidepressants come with a boxed warning from the FDA. It warns patients that antidepressants increase suicidal thoughts in children and adolescents, according to available research. Though these effects aren’t seen in adult studies, patients should be aware of the increased risk for suicidal thoughts and monitor accordingly when taking antidepressants.

Strattera interactions

Strattera has 335 known drug interactions, 9 disease interactions, and 1 alcohol/food interactions, according to drugs.com. Any of which could worsen unwanted side effects. To avoid drug interactions, inform your provider about any medications (prescription or otherwise), vitamins, and supplements you’re taking before starting Strattera. 

Drug interactions

Strattera interacts with monoamine oxidase inhibitors (MAOIs) and blood pressure medications. It also has major interactions with antidepressants Lexapro (escitalopram) and Prozac (fluoxetine) and moderate interactions with the following: 

• Adderall (amphetamine/dextroamphetamine)
• Cymbalta (duloxetine)
• Vyvanse (lisdexamfetamine)
• Wellbutrin (bupropion)
• Zoloft (sertraline)

Disease interactions

Strattera is contraindicated (not recommended) for people with the following medical conditions: 

• Cardiac disease
• Glaucoma
• Narrow-angle glaucoma
• Hypertension
• Liver disease
• Psychiatric disorders
• Renal (kidney) dysfunction
• Seizure disorders
• Urinary retention

Alcohol/food interactions

Strattera has moderate interactions with caffeine. Exercise caution when consuming these foods while taking Strattera.

What is Focalin?

Focalin is a CNS stimulant used to treat ADHD. It’s in the same class of medication as Adderall and Ritalin (methylphenidate) and works similarly.

How does Focalin work?

As a CNS stimulant, Focalin increases norepinephrine and dopamine levels in the brain’s synapses, which relieves the hyperactive, impulsive, and inattentive symptoms of ADHD and creates a sense of euphoria or well-being. 

Focalin forms and doses

Focalin is available as a tablet in both immediate-release and extended-release (XR) forms. It’s taken with or without food.

Immediate-release tablet strengths range from 2.5 to 10 milligrams. You’ll likely start with 10 milligrams once daily if prescribed the immediate-release form of Focalin. The maximum daily dose for immediate-release tablets is 20 milligrams. 

Focalin XR tablets come in 8 different doses. If you’re prescribed extended-release tablets, you’ll start with 10 milligrams once a day (either the 10-milligram tablet or 2 5-milligram tablets). Your dosage varies if you’re currently on another stimulant, but you could take up to 40 milligrams per day. Be sure to inform your doctor if you take other medications alongside Focalin. 

If you’re unable to swallow pills, or don’t like to, Focalin can be sprinkled into food. If you do take it with food, don’t chew it. Instead, swallow it whole with a food like applesauce or a smoothie. 

What Focalin treats

Focalin is primarily prescribed to treat common symptoms of ADHD, such as impulsiveness, hyperactivity, and inattentiveness. It’s also used to treat narcolepsy, but this is an off-label (not FDA-approved) use.

What’s the price of Focalin?

Without insurance, immediate-release Focalin costs $80 to $156 and Focalin XR costs $527 to $605, depending on the dosage and pharmacy. This is according to drugs.com with their discount card. Your actual price may vary. 

If you have health insurance, your payment is based on your drug copay. 

Focalin side effects

Focalin’s side effects include abdominal pain, fever, anorexia, and nausea. People taking Focalin may also experience:

• Circulation problems in fingers and toes
• Painful and prolonged erections
• Slowed growth in children
• Eye problems
• New or worsening tics or Tourette’s syndrome

Precautions and warnings with Focalin

As a CNS stimulant, Focalin is a Schedule II controlled substance heavily regulated by the U.S. Drug Enforcement Administration (DEA). It has the potential for dependency and abuse, and should only be used under the supervision of your healthcare provider. Take it as prescribed and don’t increase or decrease your dosage without medical advice. If you have a history of substance abuse or dependency, tell your provider before starting Focalin.

If you need to stop taking Focalin, consult your provider. Abruptly stopping CNS stimulants can lead to withdrawal symptoms. To prevent this, your provider will help you taper off the medication over time.

Focalin interactions

Focalin interacts with 198 drugs, 13 diseases, and 1 alcohol/foods, according to drugs.com. These interactions can cause or worsen unwanted side effects. Tell your healthcare provider about your current medications, medical history, and diet to prevent negative interactions.

Drug interactions

Focalin has moderate interactions with other ADHD medications, including Adderall, blood pressure medications, MAOIs, and some surgical-grade anesthetics.

Disease interactions

Focalin can interfere with or worsen symptoms of certain medical conditions, including:

• Agitation
• Cardiac disease
• Glaucoma
• Hematologic toxicity
• Hypertension
• Liver disease
• Psychiatric disorders
• Renal (kidney) dysfunction
• Seizure disorders
• Substance abuse
• Tics

Alcohol/food interactions

Because Focalin stimulates the nervous system, it moderately interacts with caffeine. If you regularly consume caffeine, talk to your provider. They may suggest reducing your caffeine intake while using Focalin for ADHD.

Find a provider on Klarityh and find the best ADHD medication for you

Unsure whether Strattera or Focalin is better for managing your ADHD symptoms? Find out with the help of a licensed healthcare professional on Klarity. Your provider can evaluate your ADHD treatment needs and determine which medication, if any, is best for you. Find an ADHD provider on Klarity today and have an appointment in as little as 24 hours.

Sources

Cleveland Clinic, Serotonin, Mar. 2022, https://my.clevelandclinic.org/health/articles/22572-serotonin

DailyMed, Label: Focalin- dexmethylphenidate hydrochloride tablet, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7c552f11-e24a-4d9b-bb8d-be10c928eca8

DailyMed, Label: Focalin XR- dexmethylphenidate hydrochloride capsule, extended release, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1a1da905-42a0-4748-9c39-67eca45deccc

DailyMed, Label: Strattera- atomoxetine capsule, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0121363e-dcd9-4c24-940b-ea890ab762e7

Drugs.com, Dexmethylphenidate Prices, Coupons, and Patient Assistance Programs, https://www.drugs.com/price-guide/dexmethylphenidate

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Drugs.com, Strattera Prices, Coupons and Patient Assistance Programs, https://www.drugs.com/price-guide/strattera#:~:text=The%20cost%20for%20Strattera%20oral,accepted%20at%20most%20U.S.%20pharmacies.

Mayo Clinic, Atomoxetine (oral route), https://www.mayoclinic.org/drugs-supplements/atomoxetine-oral-route/side-effects/drg-20066904?p=1

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National Library of Medicine, Atomoxetine, https://www.ncbi.nlm.nih.gov/books/NBK493234/

The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health.

If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

How we reviewed this article: This article goes through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author.