What are non-stimulant medications?

From the Guidelines

Non-stimulant medications, such as atomoxetine, guanfacine, and clonidine, are effective alternatives for treating attention deficit hyperactivity disorder (ADHD) and should be considered as first-line treatment options in patients with certain comorbidities, including disruptive behavior disorders, tic disorder, Tourette's syndrome, and substance use disorders. When selecting a non-stimulant medication, atomoxetine is typically the preferred option, with a recommended starting dose of 40mg daily and gradual increase to 80-100mg daily for adults or weight-based dosing for children (0.5-1.2 mg/kg/day) 1. Other non-stimulant options include alpha-2 adrenergic agonists like guanfacine at 1-4mg daily and clonidine at 0.1-0.4mg daily, which have been shown to be efficacious in treating ADHD, particularly in patients with hyperactivity and impulsivity 1. Key benefits of non-stimulant medications include their non-controlled status, "around-the-clock" effects, and lower risk of adverse effects, such as decreased appetite and growth/height problems, compared to stimulants 1. Regular monitoring for blood pressure changes, mood effects, and other side effects is necessary, with dosage adjustments made accordingly 1. In patients with sleep disturbances, clonidine and guanfacine may be considered due to their potential to improve sleep quality 1. Overall, non-stimulant medications play an important role in the treatment of ADHD, particularly in patients with certain comorbidities or those who experience intolerable side effects with stimulants.

Some key points to consider when prescribing non-stimulant medications include:

• Atomoxetine has been shown to be associated with improved functional impairment and quality of life in patients with ADHD 1
• Guanfacine and clonidine have been approved as adjunctive therapy to stimulant medications, which can increase treatment effects and/or decrease adverse effects of stimulants 1
• Non-stimulant medications may take 2-4 weeks to reach full effectiveness, unlike the immediate effects of stimulants 1
• Regular monitoring for adverse effects, such as somnolence/fatigue, is necessary, particularly with clonidine and guanfacine 1.

In terms of specific patient populations, non-stimulant medications may be particularly beneficial for:

• Patients with anxiety or autism spectrum disorder, as atomoxetine has been shown to be effective in reducing symptoms of anxiety and improving functioning in these patients 1
• Patients with tic disorders, as guanfacine may reduce tics, although evidence is inconclusive 1
• Patients with substance use disorders, as non-stimulant medications may be a safer alternative to stimulants due to their lower potential for abuse 1.

Overall, non-stimulant medications are a valuable treatment option for patients with ADHD, particularly those with certain comorbidities or those who experience intolerable side effects with stimulants, and should be considered as part of a comprehensive treatment plan 1.

From the FDA Drug Label

There are no adequate and well-controlled studies examining sexual dysfunction with atomoxetine hydrochloride treatment. 6. 2 Postmarketing Spontaneous Reports The following adverse reactions have been identified during post approval use of atomoxetine hydrochloride. 7 DRUG INTERACTIONS Atomoxetine hydrochloride should be used cautiously with antihypertensive drugs and pressor agents (e.g., dopamine, dobutamine) or other drugs that increase blood pressure.

Non-stimulant medications like atomoxetine hydrochloride are used to treat ADHD.

• Key points about atomoxetine hydrochloride include:
  • It should be used cautiously with certain medications, such as antihypertensive drugs and pressor agents.
  • It has been associated with various adverse reactions, including cardiovascular effects and psychiatric disorders. The FDA drug label for atomoxetine hydrochloride provides information on its use, dosage, and potential interactions with other medications 2.

From the Research

Non-Stimulant Medications for ADHD

• Non-stimulant medications are used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in patients who do not respond to or cannot tolerate stimulants 3, 4.
• Atomoxetine is a non-stimulant medication that has been extensively studied and shown to be effective in treating ADHD in children, adolescents, and adults 3, 4, 5.
• Other non-stimulant medications that have been used to treat ADHD include tricyclic antidepressants, alpha-2-adrenergic agonists, and antidepressants with noradrenergic or dopaminergic components 4, 5, 6.

Mechanism of Action and Efficacy

• Atomoxetine works by selectively inhibiting the presynaptic norepinephrine transporter, which enhances noradrenergic function 3.
• Clinical trials have shown that atomoxetine is safe and well-tolerated, with mild to moderate and transient adverse events 3, 4.
• Non-stimulant medications have been shown to be effective in treating ADHD symptoms and improving functional outcomes, including quality of life and academic performance 7, 6.

Treatment Options and Considerations

• Non-stimulant medications can be used as monotherapy or in combination with other medications to treat ADHD 6.
• The choice of non-stimulant medication depends on the individual patient's needs and circumstances, including comorbid disorders and medical history 5, 6.
• Further research is needed to understand the mechanisms of action of non-stimulant medications and to examine their effects on commonly occurring comorbidities 5, 7.