Comparison of Strattera (Atomoxetine) vs. Qelbree (Viloxazine) for ADHD Symptom Control
Based on the available evidence, Strattera (atomoxetine) is preferred over Qelbree (viloxazine) for ADHD symptom control due to its more established efficacy profile and greater body of clinical evidence.
Mechanism of Action
- Strattera (Atomoxetine): Selective norepinephrine reuptake inhibitor (NRI) that inhibits presynaptic norepinephrine transporters in the prefrontal cortex 1
- Qelbree (Viloxazine): Selective norepinephrine reuptake inhibitor with activity in both noradrenergic and serotonergic pathways 2
Efficacy Comparison
Strattera (Atomoxetine)
- Well-established efficacy demonstrated through multiple clinical trials
- Effective for both short-term and long-term ADHD management 1
- Single morning dose shown to be effective throughout the day and into the evening 1
- Target dose of 1.2 mg/kg/day or maximum 100 mg/day 3, 4
- Significant improvements in ADHD Rating Scale scores compared to placebo 4
- Improvements in social functioning, family functioning, and self-esteem 4
Qelbree (Viloxazine)
- Newer medication with less extensive clinical evidence
- Limited data on long-term efficacy and safety 5
- Shows promise with "relatively rapid onset of action" and "sustained symptom improvement" 5
- Limited data on efficacy for adults with ADHD 3
- Target dose range: 200-600 mg/day 3
Safety Profile
Strattera (Atomoxetine)
- Generally well-tolerated with established safety profile 1, 4
- Common side effects: headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea 1
- Minimal risk of abuse potential 1, 6
- May cause slight increases in heart rate and blood pressure 1
- Black box warning for suicidal ideation 1
- Rare risk of serious liver injury 1
Qelbree (Viloxazine)
- Limited long-term safety data available 3
- Decreased chance of substance abuse, drug dependence, and withdrawal symptoms 2
- Limited data on safety during pregnancy 3
Special Considerations
Pregnancy and Breastfeeding
- Strattera: Limited data, but does not appear to be associated with major congenital malformations or adverse obstetrical outcomes 3
- Qelbree: No published studies on safety during pregnancy 3
- Breastfeeding: Caution advised for both medications 3
Comorbid Conditions
- Strattera: Effective in patients with comorbid anxiety, tics, or substance use disorders 1, 6
- Qelbree: Limited data on efficacy for comorbid conditions
Dosing Convenience
- Strattera: Can be administered once daily or split into two doses 1, 6
- Qelbree: Once-daily extended-release formulation 3, 5
Clinical Decision Algorithm
- First-line treatment: Consider stimulants (methylphenidate or amphetamines) as recommended by guidelines 7
- If stimulants are contraindicated, not tolerated, or ineffective:
- Choose Strattera (atomoxetine) as the preferred non-stimulant option due to more established efficacy and safety profile
- Consider Qelbree (viloxazine) only if Strattera is ineffective or not tolerated
- Special situations favoring Strattera:
- Patients with risk of substance abuse
- Patients with comorbid anxiety or tics
- Patients requiring long-term treatment (more data available)
Monitoring Recommendations
- Regular assessment of vital signs, growth parameters, and side effects
- Monitor for decreased appetite, sleep disturbances, and potential growth effects
- Document height, weight, blood pressure, and heart rate before starting medication and during follow-up visits
In conclusion, while both medications are effective non-stimulant options for ADHD, Strattera has a more established track record with greater evidence supporting its efficacy and safety profile, making it the preferred choice between these two medications for ADHD symptom control.