From the Guidelines
Non-stimulant treatments for ADHD, such as atomoxetine, guanfacine, and clonidine, are recommended as second-line treatment options due to their relatively smaller effect sizes compared to stimulants, but they offer advantages for patients with certain comorbidities or adverse effects from stimulants 1. When considering non-stimulant treatments for ADHD, it is essential to weigh the benefits and limitations of each medication. Atomoxetine, for example, has been shown to improve functional impairment and quality of life, with a medium effect size compared to placebo 1. Guanfacine and clonidine have also been found to be efficacious in treating ADHD, although their effect sizes are generally smaller than those of stimulants 1. The treatment effects of non-stimulants may take longer to observe, typically within 2-6 weeks, compared to stimulants, which have a more rapid onset of action 1. However, non-stimulants offer the advantage of providing 24-hour symptom coverage without the peaks and valleys associated with stimulant medications. Some key considerations when prescribing non-stimulant medications include:
- Atomoxetine is typically started at 40mg daily for adults and children over 70kg, gradually increasing to 80-100mg daily as needed 1.
- Guanfacine is usually prescribed at 1-4mg once daily, while clonidine is given at 0.1-0.4mg daily, often divided into smaller doses 1.
- Non-stimulants may be considered as first-line treatment options in patients with disruptive behavior disorders, tic disorder, Tourette's syndrome, or substance use disorders, where stimulants may be contraindicated due to their dopaminergic activity 1.
- Behavioral therapy, particularly cognitive behavioral therapy, is an important non-pharmacological approach that can be used alone or alongside medication to develop organizational skills, time management, and emotional regulation strategies 1.
From the FDA Drug Label
Atomoxetine capsules are indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) The efficacy of atomoxetine capsules was established in seven clinical trials in outpatients with ADHD: four 6 to 9-week trials in pediatric patients (ages 6 to 18), two 10-week trial in adults, and one maintenance trial in pediatrics (ages 6 to 15)
Non-stimulant treatment for ADHD: Atomoxetine is a non-stimulant medication approved for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in pediatric and adult patients 2.
- Key points:
- Atomoxetine is indicated as an integral part of a total treatment program for ADHD.
- The medication is not approved for major depressive disorder.
- It is essential to monitor patients closely for suicidality, clinical worsening, or unusual changes in behavior.
From the Research
Non-Stimulant Treatment Options for ADHD
- Atomoxetine is a non-stimulant drug approved by the FDA for the treatment of ADHD in children, adolescents, and adults 3, 4, 5.
- Atomoxetine works by inhibiting the presynaptic norepinephrine transporter, which helps to control and maintain ADHD symptoms 3.
- Clinical trials have shown that atomoxetine is effective in treating ADHD, with similar efficacy to methylphenidate, but without the abuse liability associated with some psychostimulants 3, 5.
- Other non-stimulant medications that may be used to treat ADHD include tricyclic antidepressants, alpha-2 agonists, and bupropion 6, 4, 7.
- These medications may be used as alternative treatment options for patients who do not respond to or cannot tolerate stimulants 6, 5, 7.
Safety and Efficacy of Non-Stimulant Treatments
- Atomoxetine has been shown to be safe and well-tolerated, with mild to moderate adverse events, such as nausea, vomiting, and decreased appetite 3, 5.
- Long-term studies have shown that atomoxetine is effective in preventing relapse of ADHD symptoms without an increase in adverse effects 3.
- Other non-stimulant medications, such as tricyclic antidepressants and alpha-2 agonists, may have more significant side effects and require careful consideration of safety aspects and precautions 6, 4.
Current Research and Recommendations
- Current guidelines recommend stimulants and behavior modification as first-line therapy for the management of ADHD, but atomoxetine and other non-stimulant medications may be considered as alternative treatment options 5, 7.
- Further research is needed to identify and test more personalized treatment strategies for adults with ADHD, including the use of non-stimulant medications 7.