From the Guidelines
Non-amphetamine treatment options for ADHD include atomoxetine, guanfacine, and clonidine, which are effective alternatives to amphetamine-based stimulants. These medications work through different mechanisms, such as increasing norepinephrine levels in the brain or affecting norepinephrine signaling, to regulate attention and manage ADHD symptoms.
Key Non-Amphetamine Options
- Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor typically started at 40mg daily and titrated up to 80-100mg daily for adults, as indicated by 1.
- Guanfacine (Intuniv) and clonidine (Kapvay), both alpha-2 adrenergic agonists, are often prescribed at 1-4mg and 0.1-0.4mg daily respectively, as noted in 1 and 1.
- Viloxazine (Qelbree) is a newer option that modulates norepinephrine and serotonin, with dosing ranging from 100-600mg daily based on age and response.
- Bupropion (Wellbutrin), though off-label for ADHD, is sometimes prescribed at 150-300mg daily and works by inhibiting dopamine and norepinephrine reuptake.
Considerations for Use
These medications typically take 2-4 weeks to reach full effectiveness, unlike the immediate effects of stimulants, and are particularly useful for patients with stimulant contraindications, substance use concerns, or those experiencing significant side effects from amphetamine medications, as discussed in 1 and 1. Non-pharmacological approaches like cognitive behavioral therapy, mindfulness training, and organizational skills coaching can complement medication treatment and provide additional support for managing ADHD symptoms.
Important Factors
When selecting a non-amphetamine treatment option, factors such as the patient's medical history, presence of comorbidities, and potential side effects should be considered, as emphasized in 1 and 1. Regular monitoring and adjustments to the treatment plan may be necessary to ensure optimal outcomes and minimize adverse effects.
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)
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) [see Clinical Studies (14)].
Non-amphetamine treatment options for ADHD include atomoxetine capsules, as indicated by the drug label 2.
- Atomoxetine is a non-AMP treatment option for ADHD, established through seven clinical trials in outpatients with ADHD.
- The drug label indicates that atomoxetine capsules are indicated for the treatment of ADHD, as part of a total treatment program that may include other measures.
From the Research
Non-Amphetamine Treatment Options for ADHD
- Non-stimulant agents, such as tricyclic antidepressants (TCAs), bupropion, and atomoxetine, can be used as second-line treatments for ADHD 3
- Atomoxetine, a selective norepinephrine reuptake inhibitor, has been shown to be efficacious in the treatment of ADHD and has a more favorable side-effect profile than TCAs 3, 4
- Atomoxetine is effective and generally well tolerated in children and adolescents with ADHD, and can be administered as a single daily dose or split into two evenly divided doses 4
- Atomoxetine is also effective in adults with ADHD, and is a valuable new treatment option for those who are at risk for substance abuse or who do not wish to take a controlled substance 5, 6
Mechanism of Action and Pharmacokinetics
- Atomoxetine works by selectively inhibiting the presynaptic norepinephrine transporter, which enhances noradrenergic function 7
- Atomoxetine is rapidly absorbed from the gastrointestinal tract, reaching peak levels in 1.83 hours in pediatric patients and 1-1.5 hours in adults 7
- Atomoxetine undergoes extensive biotransformation, which is affected by poor metabolism by cytochrome P450 (CYP) 2D6 in a small percentage of the population 4
Efficacy and Safety
- Atomoxetine has been shown to be significantly more effective than placebo in the treatment of ADHD in children, adolescents, and adults 3, 4, 6
- Atomoxetine is generally well tolerated, with common adverse events including headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 4, 6
- Atomoxetine has a negligible risk of abuse or diversion, and is not a controlled substance in the US 4, 6