Strattera Vs. Wellbutrin: Drug Comparison

Strattera^® (atomoxetine) is a non-stimulant medication used to treat attention-deficit hyperactivity disorder (ADHD) by selectively inhibiting the reuptake of norepinephrine, which helps improve focus and reduce impulsivity. Its FDA-approved indication is for the treatment of ADHD in both children and adults. Strattera is available in capsule form, taken once or twice daily. Common side effects include dry mouth, insomnia, decreased appetite, and nausea, while more serious risks include increased heart rate and blood pressure. Strattera carries a boxed warning for an increased risk of suicidal thoughts in children and adolescents, especially during the initial treatment period.

Wellbutrin SR^® (bupropion sustained-release) is an antidepressant that works by inhibiting the reuptake of norepinephrine and dopamine in the brain, which helps improve mood and reduce symptoms of depression. Its FDA-approved indication includes the treatment of major depressive disorder (MDD). Off-label uses may include smoking cessation, anxiety, and attention-deficit hyperactivity disorder (ADHD). Wellbutrin SR is available in sustained-release tablet form, typically taken once or twice daily. Common side effects include insomnia, dry mouth, constipation, and headache, and it has a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults during the initial stages of treatment.

Selective norepinephrine reuptake inhibitor (SNRI)

Aminoketone antidepressant

Strattera (atomoxetine hydrochloride) is indicated:

• For the treatment of attention-deficit/hyperactivity disorder (ADHD)

Wellbutrin SR (bupropion hydrochloride) is indicated:

• For the treatment of major depressive disorder (MDD)

• Typically taken orally once or twice daily

• Comes in 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, and 100 mg capsules

• Typically taken orally twice daily

• Comes in 100 mg, 150 mg, and 200 mg tablets

Most common adverse reactions (≥5% and at least twice the incidence of placebo patients):

Child and adolescent clinical trials:

• Nausea

• Vomiting

• Fatigue

• Decreased appetite

• Abdominal pain

• Sleepiness

Adult clinical trials:

• Constipation

• Dry mouth

• Nausea

• Decreased appetite

• Dizziness

• Erectile dysfunction

• Urinary hesitation

Most common adverse reactions (incidence ≥5% and ≥2% more than placebo rate) are:

• Headache

• Dry mouth

• Nausea

• Insomnia

• Dizziness

• Inflammation of the throat

• Constipation

• Agitation

• Anxiety

• Abdominal pain

• Ringing in the ears

• Tremor

• Fluttering heartbeat

• Muscle pain

• Sweating

• Rash

• Anorexia

• Hypersensitivity to atomoxetine or other constituents of product

• Strattera use within 2 weeks after discontinuing MAOI or other drugs that affect brain monoamine concentrations

• Narrow angle glaucoma

• Pheochromocytoma or history of pheochromocytoma

• Severe cardiovascular disorders that might deteriorate with clinically important increases in HR and BP

• Drug interactions: monoamine oxidase inhibitors (MAOIs), CYP2D6 inhibitors, antihypertensive drugs and pressor agents, albuterol (or other beta agonists)

• Seizure disorder

• Current or prior diagnosis of bulimia or anorexia nervosa

• Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, antiepileptic drugs

• Monoamine oxidase inhibitors (MAOIs)

• Known hypersensitivity to bupropion or other ingredients of Wellbutrin SR.

• Drug interactions: CYP2B6 inducers, drugs metabolized by CYP2D6, digoxin, drugs that lower seizure threshold, dopaminergic drugs (levodopa and amantadine), MAOIs

• Drug-laboratory test interactions: Wellbutrin SR can cause false-positive urine test results for amphetamines

• Suicidal ideation

• Severe liver injury

• Serious cardiovascular events

• Emergent cardiovascular symptoms

• Effects on blood pressure and heart rate

• Emergent psychotic or manic symptoms

• Bipolar disorder

• Aggressive behavior or hostility should be monitored

• Possible allergic reactions, including anaphylactic reactions, angioneurotic edema, urticaria, and rash

• Effects on urine outflow

• Prolonged erection

• Growth

• Concomitant use of potent CYP2D6 inhibitors or use in patients known to be CYP2D6 PMs

• Neuropsychiatric adverse events during smoking cessation

• Seizure risk

• High blood pressure

• Activation of mania/hypomania

• Psychosis and other neuropsychiatric reactions

• Angle-closure glaucoma

WARNING: SUICIDAL IDEATION IN CHILDREN AND ADOLESCENTS

Increased risk of suicidal ideation in children or adolescents.

No suicides occurred in clinical trials.

Patients started on therapy should be monitored closely.

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thinking and behavior in children, adolescents and young adults taking antidepressants.

Monitor for worsening and emergence of suicidal thoughts and behaviors.

*This information is from the label for brand name Strattera^®. See the Full Prescribing Information for more complete information. Atomoxetine, the active ingredient in Strattera, is also the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient atomoxetine.

*This information is from the label for brand name Wellbutrin SR^®. See the Full Prescribing Information for more complete information. Bupropion, the active ingredient in Wellbutrin XL, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient bupropion.