What are non-stimulant Attention Deficit Hyperactivity Disorder (ADHD) medication options?

From the Guidelines

Non-stimulant medications for ADHD, such as atomoxetine, guanfacine, and clonidine, are effective alternatives to stimulants, particularly for patients with comorbid conditions or those who experience adverse effects from stimulants, as supported by the most recent study 1.

Key Non-Stimulant Medications

• Atomoxetine (Strattera): typically started at 40mg daily, increasing to 80-100mg daily
• Guanfacine (Intuniv): usually prescribed at 1-4mg once daily
• Clonidine (Kapvay): given at 0.1-0.4mg daily, often divided into doses

Mechanism of Action

These medications work differently than stimulants:

• Atomoxetine increases norepinephrine in the brain
• Guanfacine and clonidine are alpha-2 adrenergic agonists that help regulate attention and impulse control

Clinical Considerations

Non-stimulants are particularly useful for patients who:

• Experience adverse effects from stimulants
• Have concerns about stimulant abuse potential
• Have comorbid conditions like anxiety, tics, or substance use disorders

Important Notes

• Non-stimulants typically take 2-4 weeks to reach full effectiveness and should be taken consistently rather than as needed
• Side effects vary by medication but may include drowsiness, dry mouth, decreased appetite, and potential cardiovascular effects requiring monitoring, as reported in 1 and 1

Recommendations

Based on the most recent and highest quality study 1, atomoxetine, guanfacine, and clonidine are recommended as non-stimulant medication options for ADHD, considering their efficacy and safety profiles.

From the FDA Drug Label

1 INDICATIONS AND USAGE

1. 1 Attention-Deficit/Hyperactivity Disorder (ADHD) Atomoxetine capsules are indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD)

Non-stimulant ADHD medication options include:

• Atomoxetine: a selective norepinephrine reuptake inhibitor, as indicated in the drug label 2 and 2.

The drug label does not provide a comprehensive list of non-stimulant ADHD medication options, only information about atomoxetine.

From the Research

Non-Stimulant Medication Options for ADHD

• Atomoxetine (Strattera) is the only FDA-approved non-stimulant medication for ADHD, effective for the entire spectrum of symptoms in both children and adults 3, 4, 5, 6, 7
• Other non-stimulant medications used to treat ADHD include:
  • Bupropion (Wellbutrin) 3, 6, 7
  • Alpha-2 agonists such as guanfacine (Tenex) and clonidine (Catapres) 3, 5, 6, 7
  • Tricyclic antidepressants (TCAs) such as desipramine or imipramine 3, 6, 7
• Modafinil (Provigil) is being studied for the treatment of pediatric ADHD 3
• Cholinergic agents, such as acetylcholinesterase inhibitors (tacrine, donepezil) and novel nicotinic analogues (ABT-418), are being explored as potential treatments for ADHD 7

Safety and Efficacy of Non-Stimulant Medications

• Non-stimulant medications are generally well-tolerated, with side effects being mostly mild to moderate and transient 4, 6, 7
• Atomoxetine has been shown to be safe and effective in treating ADHD, with a recommended dosing of 1.2 mg/kg/day in children and adolescents weighing 70 kg or less, and 80 mg/day in children and adolescents weighing over 70 kg and adults 4
• Special safety aspects and precautions should be considered when using non-stimulant medications, including potential interactions with other medications and comorbid conditions 6