Strattera vs. Adderall: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Is your child struggling with school? Does he or she fidget all day? Does your child have a short attention span or exhibit impulsivity? Whether you or your child has been newly diagnosed with attention deficit hyperactivity disorder (ADHD) or has been struggling with it for a while, your healthcare provider may have suggested adding an ADHD medication as part of a comprehensive treatment plan, which includes psychological, educational, and social measures.

There are many ADHD medications that are approved by the FDA. Strattera and Adderall are two drugs commonly used for the treatment of ADHD symptoms.

Strattera is a non-stimulant medication used to treat patients with adult or childhood ADHD. Strattera contains atomoxetine. Strattera is not a controlled substance. It is classified as a selective norepinephrine reuptake inhibitor and is not a stimulant, unlike many other common ADHD drugs.

Adderall is a stimulant medication used to treat patients with adult ADHD or childhood ADHD. Adderall is also used to treat narcolepsy in adults or children. Adderall contains dextroamphetamine/amphetamine (amphetamine salts). Adderall is classified as a Schedule II drug because there is a high potential for abuse.

What are the main differences between Strattera and Adderall?

Strattera (What is Strattera?) is a selective norepinephrine reuptake inhibitor used to treat ADHD in adults and children. The generic name of Strattera is atomoxetine. The way it works is not completely understood but is thought to be related to selective inhibition of the presynaptic norepinephrine transporter.

Adderall (What is Adderall?) is a central nervous system stimulant drug used in the treatment of ADHD and narcolepsy in adults and children. It is available in an immediate-release tablet and extended-release capsule (XR) form; both are available in brand and generic. Adderall XR is indicated for the treatment of ADHD, but not narcolepsy. The generic name is dextroamphetamine/amphetamine. Like Strattera, the way Adderall works is not completely understood. It is thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase their release into the extraneuronal space.

Main differences between Strattera and Adderall
	Strattera	Adderall
Drug class	Selective norepinephrine reuptake inhibitor	CNS stimulant
Brand/generic status	Brand and generic	Brand and generic
What is the generic name?	Atomoxetine	Dextroamphetamine/amphetamine
What form(s) does the drug come in?	Capsule	Tablet, extended-release (XR) capsule
What is the standard dosage?	ADHD in adults: Start at 40 mg per day, increase after at least 3 days to a target total daily dose of 80 mg (given as 80 mg once daily in the morning, or as 40 mg in the morning and 40 mg in the late afternoon or early evening). After 2-4 additional weeks, the dose may be increased to a maximum dose of 100 mg if necessary. ADHD in children: varies by weight	Immediate release: ADHD (adults): 5-40 mg per day (divided once, twice, or 3 times daily) Narcolepsy (adults): 5-60 mg per day (divided once, twice or 3 times daily) ADHD (children): 3-5 years old: 2.5-40 mg per day (divided once, twice, or 3 times daily) 6 years and older: 5-40 mg per day (divided once, twice, or 3 times daily) Narcolepsy in children: 6 years and older: 5-60 mg per day (divided once, twice, or 3 times daily) XR capsule (adults): 20 mg once daily XR capsule (children): 10-20 mg once daily
How long is the typical treatment?	Varies; healthcare provider should periodically reevaluate if used for extended period	Not studied for long-term use, patients should be frequently evaluated. Package insert comes with a warning: “Administration of amphetamines for prolonged periods of time may lead to drug dependence and must be avoided.”
Who typically uses the medication?	Adults or children (6 years and older) with ADHD	Adults or children with ADHD or narcolepsy (narcolepsy: immediate-release form only) (for ADHD ages 3 years and older; for narcolepsy ages 6 years and older)

Conditions treated by Strattera and Adderall

Strattera is used in adults and children for the treatment of ADHD. Adderall is used in adults and children for the treatment of ADHD or narcolepsy. Strattera or Adderall is intended to be part of a total treatment program for ADHD that may include psychological, educational, and social measures. The decision to treat ADHD with medication may occur when remedial measures (such as educational placement and therapy) are not effective and depends on the healthcare provider’s assessment of the length and severity of the patient’s symptoms.

Adderall has not been studied for long-term use. Patients who take Adderall for extended periods should be periodically evaluated while on the medication, to ensure the medication is still useful.

Condition	Strattera	Adderall
ADHD	Yes	Yes
Narcolepsy	Off-label	Yes (immediate-release form only, not XR)

Is Strattera or Adderall more effective?

While efficacy and safety studies have been completed to bring each drug to market, there is no data directly comparing the two drugs. When deciding which drug is more effective for you, your healthcare provider will look at the full picture, including your symptoms/medical conditions, medical history, and any other medications you take that may interact with Strattera or Adderall.

Other factors must be taken into consideration, too. For example, if you have a history of a substance use disorder, you may be more suited to take a non-controlled ADHD medication like Strattera, which is not addictive. Or, if the price is your only determining factor and you have no other medical conditions or potential issues, generic Adderall tablets may be a better choice. Your healthcare provider is the best source of information based on each individual.

Coverage and cost comparison of Strattera vs. Adderall

Strattera is covered by most insurance plans and Medicare Part D. The out-of-pocket price for a typical prescription of Strattera (generic, 30 count, 40 mg) is about $387. You can use a SingleCare card to bring the price of generic Strattera less than $200.

Most insurance plans and Medicare Part D usually cover Adderall (brand and generic). Some insurance companies actually prefer brand-name Adderall XR over the generic alternative, due to insurance contracts. The out-of-pocket price for a typical prescription of Adderall (generic, 60 count, 20 mg) is about $100. A SingleCare card can save you money on your Adderall prescription, bringing the price to less than $30.

	Strattera	Adderall
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Usually; copay will vary
Standard dosage	Example: generic Strattera 40 mg, 30 count	Example: generic Adderall 20 mg, 60 count
Typical Medicare Part D copay	$1-$8	$7-$78
SingleCare cost	$199+	$29+

Get the pharmacy discount card

Common side effects of Strattera vs. Adderall

Side effects of Strattera:

In children and adolescents, the most common side effects of Strattera are abdominal pain, vomiting, nausea, fatigue, decreased appetite, headache, drowsiness, and dizziness.

In adults, the most common side effects of Strattera include dry mouth, nausea, constipation, dizziness, decreased appetite, abdominal pain, fatigue, erectile dysfunction, and insomnia.

Side effects of Adderall:

In ages 6 to 12, the most common side effects of Adderall are appetite loss, insomnia, abdominal pain, mood changes, vomiting, nervousness, nausea, and fever.

In adolescents (ages 13 to 17), the most common side effects of Adderall are loss of appetite, sleep disorder, abdominal pain, weight loss, and nervousness.

In adults, the most common side effects of Adderall are dry mouth, loss of appetite, insomnia, headache, weight loss, nausea, anxiety, agitation, dizziness, tachycardia (rapid heartbeat), diarrhea, weakness, and urinary tract infections.

This is not a full list of side effects—other side effects may occur. Consult your healthcare professional for more information on side effects.

	Strattera*		Adderall
Side effect	Applicable?	Frequency	Applicable?	Frequency
Dry mouth	Yes	20%	Yes	Not reported
Nausea	Yes	26%	Yes	Not reported
Constipation	Yes	8%	Yes	Not reported
Abdominal pain	Yes	7%	Yes	Not reported
Fatigue	Yes	10%	Yes	Not reported
Decreased appetite	Yes	16%	Yes	Not reported
Dizziness	Yes	8%	Yes	Not reported
Insomnia	Yes	15%	Yes	Not reported
Erectile dysfunction	Yes	8%	Yes	Not reported

*Strattera percentages listed are from adult studies

Source: DailyMed (Strattera), DailyMed (Adderall)

Drug interactions of Strattera vs. Adderall

The dosage of Strattera may need to be adjusted if given with drugs that are known as potent inhibitors of an enzyme called CYP2D6. These drugs include paroxetine, fluoxetine, and quinidine.

Tricyclic antidepressants, such as Elavil (amitriptyline) or Pamelor (nortriptyline) may increase the cardiovascular side effects of Adderall; patients should be closely monitored.

Paxil (paroxetine) or Prozac (fluoxetine) are SSRI antidepressants that may increase the risk of serotonin syndrome when taken with Adderall. SNRI antidepressants such as Effexor (venlafaxine) may also pose the same risk of serotonin syndrome when taken with Adderall.

Both Strattera and Adderall have a dangerous potential drug interaction with monoamine oxidase inhibitors (MAOIs), such as selegiline. The combination can cause a serious, possibly fatal reaction. MAOIs should not be used within 14 days of Strattera or Adderall. Strattera or Adderall may also interact with blood pressure medicines. Taking Strattera or Adderall in combination with birth control pills may increase the risk of high blood pressure—blood pressure should be monitored.

This is not a full list of drug interactions. Other drug interactions may occur. Consult your healthcare provider for a full list of drug interactions.

Drug	Drug class	Strattera	Adderall
Citalopram Escitalopram Fluoxetine Paroxetine Sertraline	SSRI antidepressants	Fluoxetine & paroxetine only	Yes
Desvenlafaxine Duloxetine Venlafaxine	SNRI antidepressants	Yes (desvenlafaxine and venlafaxine)	Yes
Amitriptyline Nortriptyline	Tricyclic antidepressants	Yes	Yes
Bupropion	Aminoketone antidepressant	Yes	Yes
Rasagiline Phenelzine Selegiline Tranylcypromine	MAOI (MAO inhibitors)	Yes	Yes
Blood pressure medications	All categories	Yes	Yes
Almotriptan Rizatriptan Sumatriptan Zolmitriptan	Selective serotonin receptor agonists for migraine	Yes	Yes
Lansoprazole Omeprazole Pantoprazole	Proton pump inhibitors	Yes	Yes
Albuterol	Bronchodilator	Yes	Yes
Fluoxetine Paroxetine Quinidine	CYP2D6	Yes (in certain patients)	Yes
Oral contraceptives (birth control pills)	Oral contraceptives	Yes	Yes

Warnings of Strattera and Adderall

Warnings of Strattera:

• Strattera has a boxed warning (strong warning) of an increased risk of suicidal thoughts/ideation in children or adolescents with ADHD. Before prescribing Strattera, the risks versus benefits should be considered. Patients starting Strattera should be closely monitored for suicidal thinking or behavior, worsening, or any changes in behavior. Family and caregivers should be aware of the need for close observation, and to communicate with the prescriber.
• Strattera is approved for children and adults with ADHD. It is not approved for major depressive disorder.
• In rare cases, Strattera may cause liver injury or failure. Lab testing for liver enzyme levels should be done if there are any symptoms of liver problems such as itching, jaundice, dark urine, or flu-like symptoms.
• Sudden deaths, stroke, and heart attack have been reported at usual doses in children and adolescents with heart problems, and should not be used in patients with known heart problems. Any patient who is being considered for Strattera treatment should be evaluated for the presence of cardiac disease. Patients who develop symptoms, like chest pain, while on Strattera should be evaluated immediately.
• Strattera should be used with caution in patients who have medical conditions that could be worsened by increased blood pressure or heart rate (such as patients with high blood pressure or heart disease). Pulse and blood pressure should be measured at baseline, after any increase in dosage, and periodically, while being treated with Strattera.
• Strattera may cause psychotic or manic symptoms, such as hallucinations, delusional thinking, or mania in children and adolescents, including those without a history of these conditions.
• Patients with symptoms of depression should be screened for bipolar disorder before beginning Strattera.
• Patients beginning Strattera should be monitored for the appearance or worsening of aggressive behavior and hostility.
• Rare but serious allergic reactions, including anaphylaxis, may occur. Patients should seek emergency treatment in these cases.
• Rare cases of priapism (an erection lasting longer than four hours) have occurred. Seek prompt medical attention if priapism occurs.
• Monitor growth during Strattera treatment.

Warnings of Adderall:

• Adderall has a boxed warning (strong warning) of a high potential for abuse. Taking amphetamines for long periods of time can lead to dependence and should be avoided. Misuse of amphetamine may cause sudden death or serious cardiovascular events.
• Sudden death has been reported, even with usual doses of Adderall. Adults, and any patients with heart problems, are at higher risk.
• Blood pressure may increase, usually only slightly, but sometimes significantly. Patients should be monitored.
• Preexisting psychosis may be aggravated by Adderall. Patients should also be monitored for other mental health symptoms, such as aggression.
• Children should be monitored for growth suppression.
• The seizure threshold may be lowered.
• Visual disturbance may occur.
• Patients should be evaluated for Raynaud’s phenomenon (limited circulation to the extremities).
• Serotonin syndrome may occur. Patients should be carefully monitored and seek emergency treatment if any of these symptoms occur:
  • Mental status changes such as agitation, hallucinations, delirium, coma
  • Rapid heartbeat, fluctuating blood pressure, dizziness, sweating, flushing
  • Tremor, rigidity, incoordination
  • Seizures
  • Gastrointestinal symptoms (nausea, vomiting, diarrhea)

Frequently asked questions about Strattera vs. Adderall

What is Strattera?

Strattera (atomoxetine) is a non-stimulant medication. It is used in the treatment of ADHD in adults and children.

What is Adderall?

Adderall (dextroamphetamine/amphetamine) is a stimulant used to treat ADHD and narcolepsy in adults and children.

Are Strattera and Adderall the same?

No. Strattera and Adderall are both used to treat ADHD in adults and children (and Adderall is also used for narcolepsy); however, they have many differences such as in drug class, warnings, prices, side effects, and drug interactions, as outlined above.

Also, Strattera is not a stimulant drug. Adderall is a stimulant drug. Other stimulant drugs you may have heard of include Ritalin or Concerta (both contain methylphenidate) and Vyvanse (lisdexamfetamine).

Is Strattera or Adderall better?

While each drug can be effective, there is no data comparing the two drugs directly. Your healthcare provider can help you decide if one of these drugs is right for you.

Can I use Strattera or Adderall while pregnant?

Because there are no adequate, well-controlled studies in pregnant women, Strattera should not be used in pregnancy unless you and your healthcare provider determine that the benefits outweigh risks.

Strattera and Adderall should both be avoided while pregnant or breastfeeding.

If you become pregnant while already taking Strattera or Adderall, consult your prescriber immediately for medical advice.

Can I use Strattera or Adderall with alcohol?

No—neither of these medications should be mixed with alcohol. Alcohol can increase the side effects of Strattera and decrease its effectiveness.

Alcohol should also be avoided when taking Adderall. Too much alcohol can increase heart rate and blood pressure, which can be even more dangerous in combination with Adderall. It can even lead to a heart attack or stroke and increase the risk of alcohol poisoning.

Does Strattera help you focus?

Yes. Strattera can help treat ADHD symptoms. By increasing the amount of norepinephrine, Strattera can help with attention span and focus and reduce impulsive and hyperactive behavior.

Does Strattera make you happy?

By increasing norepinephrine, Strattera should elevate the mood (and improve concentration and other ADHD symptoms) in most cases. However, in clinical trials, mood swings occurred in 1%-2% of patients in child and adolescent studies, and 0.4% of patients in adult studies. Irritability occurred in 5% of adults in clinical trials. There is also a boxed warning of a rare incidence of suicidal thoughts/behavior that may occur with Strattera. Rarely patients may exhibit hostility, agitation, and aggressiveness while taking Strattera. While these cases are rare, it is important for patients and their families and/or caregivers to be aware of the possibility of these side effects, and contact your healthcare provider immediately if there are any changes in behavior.

Does Strattera feel like a stimulant?

Strattera is not a stimulant (like Adderall). However, Strattera does have some of the same potential side effects as Adderall and other stimulants, like a faster heartbeat or increased blood pressure. The side effects of Strattera depend upon the individual. Some people tolerate it very well and do not notice any stimulant-like side effects, while others do experience more side effects. If you are taking Strattera and notice bothersome side effects, contact your healthcare provider for guidance.