Viloxazine

• Attention-deficit/hyperactivity disorder (ADHD) in patients 6 years and older
• Non-stimulant ADHD treatment option
• ADHD in patients with substance abuse history
• ADHD with comorbid anxiety or tic disorders
• Alternative when stimulants are not tolerated

Viloxazine is a selective norepinephrine reuptake inhibitor (SNRI) approved for treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adults. Originally developed as an antidepressant in Europe, it was reformulated as an extended-release product (Qelbree) specifically for ADHD treatment in the United States.

How Viloxazine Works

Viloxazine primarily inhibits norepinephrine reuptake, increasing norepinephrine availability in the brain. It also has moderate activity at serotonin receptors (5-HT2B agonist and 5-HT2C antagonist) and weakly inhibits serotonin reuptake. This mechanism differs from stimulant medications but still improves attention and reduces impulsivity.

Available Formulations

Viloxazine extended-release capsules (Qelbree) are available in:

• 100 mg
• 150 mg
• 200 mg

Capsules can be swallowed whole or opened and sprinkled on applesauce for patients who have difficulty swallowing.

Medical Uses

Viloxazine is FDA-approved for ADHD in patients aged 6 years and older. It provides a non-stimulant option for patients who cannot tolerate or prefer to avoid stimulant medications. It may be particularly useful for patients with comorbid anxiety, tic disorders, or substance abuse history.

Dosing Information

For children aged 6-11 years, the starting dose is 100 mg once daily, which can be increased weekly to a maximum of 400 mg daily. For adolescents and adults, the starting dose is 200 mg once daily with a maximum of 400 mg daily. The medication should be taken in the morning.

Important Safety Information

Viloxazine carries a boxed warning for suicidal thoughts and behavior in children, adolescents, and young adults. Close monitoring is essential, especially during the first few months of treatment. The medication should not be used with MAO inhibitors due to risk of serious reactions.

Advantages as Non-Stimulant

Unlike stimulant ADHD medications, viloxazine is not a controlled substance and has no abuse potential. It does not cause appetite suppression or sleep problems to the same degree as stimulants. It can be used in patients with contraindications to stimulants or those with substance abuse concerns.

Drug Interactions

Viloxazine is a moderate CYP1A2 inhibitor and can increase levels of medications metabolized by this enzyme. Caution is needed with sensitive CYP1A2 substrates like duloxetine, alosetron, and theophylline. MAO inhibitors are contraindicated. Combining with other serotonergic drugs requires monitoring.

Special Populations

Safety and efficacy have been established in children 6 years and older. The medication should be used during pregnancy only if benefits outweigh risks. It is unknown whether viloxazine passes into breast milk. Dose adjustment may be needed in patients with severe renal impairment.

Clinical Response Timeline

Unlike stimulants that work immediately, viloxazine may take 1-2 weeks to show initial effects and several weeks for full therapeutic benefit. Patients should be counseled about this timeline to set appropriate expectations.

Learn more at MedlinePlus