Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2024-09-03 Encounter: Spruce text message CC: Inadequate response to starting dose of Strattera with increased hyperactivity, emotional dysregulation, and poor focus since school started. HPI: Miles started Strattera on 2024-08-20 at a starting dose. By the first day of school (2024-09-03), the parent reported worsening focus, emotional lability, difficulty settling, and loss of behavioral structure. On 2024-09-05, the parent described insane wiggles when tired, uncontrolled physical behavior (hitting, running), and unpredictable emotions — worse than his baseline. Melatonin was used once for sleep. The parent remained uncertain whether symptoms were partly attributable to school transition stress. Assessment: Miles was on a starting dose of Strattera and likely needed more time and/or a dose increase. The behaviors observed were consistent with an inadequate therapeutic dose. Dr. Hobbs recommended increasing to 50mg. Plan: Strattera increased to 50mg daily (given as 25mg x 2 capsules). On 2024-09-11, a refill was sent for 40mg of atomoxetine (Strattera generic) daily, as the available capsule sizes were 40mg and 60mg, making 50mg not a standard available formulation. Generic (atomoxetine) to be substituted automatically by pharmacy. Medications: - Strattera (atomoxetine) Increased to 50mg daily (25mg x 2); refill sent as 40mg daily (adjust) Key clinical quotes: "It's very likely he needs some more time and also likely he may need more as he is on a starting dose" "It's ok to increase the Strattera to 50mg now" "He's been taking 50mg daily and they make a 40mg and a 60mg capsule. I sent in a refill for 40mg of Strattera (Atomoxetine) daily" Source: Spruce conversation t_25GF4V55J8800