Can alum and qulbree be taken together?

Co-administration of Alum and Qelbree (Viloxazine)

Alum and Qelbree (viloxazine extended-release) should not be taken together due to potential drug interactions, particularly because viloxazine is a strong inhibitor of CYP1A2, which may affect aluminum metabolism and increase risk of adverse effects.

Understanding the Medications

Qelbree (Viloxazine Extended-Release)

• FDA-approved non-stimulant medication for attention-deficit/hyperactivity disorder (ADHD)
• Mechanism: Serotonin-norepinephrine modulator 1
• Pharmacokinetic profile:
  • Strong CYP1A2 inhibitor
  • Weak CYP2D6 and CYP3A4 inhibitor 2
  • Once-daily oral administration 1

Alum (Aluminum Hydroxide)

• Used as:
  1. Phosphate binder in kidney disease patients 3
  2. Vaccine adjuvant 4, 5
  3. Antacid component

Rationale for Contraindication

1. Enzyme Inhibition Concerns:

   • Viloxazine strongly inhibits CYP1A2 (increased substrate exposure by 436-583%) 2
   • This inhibition could potentially alter aluminum metabolism and clearance

2. Safety Guidelines:

   • According to kidney disease guidelines, aluminum-containing compounds should be avoided except for very short periods due to risk of aluminum toxicity 3
   • The ACC/AHA hypertension guidelines warn against combining medications with similar mechanisms or that target the same control systems 3

3. Risk of Aluminum Toxicity:

   • Patients with serum aluminum levels >60 μg/L should have the source of aluminum identified and eliminated 3
   • Aluminum toxicity can lead to bone disease and neurological complications 3

Monitoring Recommendations

If these medications must be used concurrently (which is not recommended):

1. Monitor for signs of aluminum toxicity:

   • Serum aluminum levels (recommend checking twice yearly) 3
   • Bone pain or fractures
   • Neurological symptoms

2. Monitor for Qelbree side effects:

   • Common adverse effects: somnolence, fatigue, irritability, decreased appetite, headache 1
   • Cardiovascular effects: potential QT interval prolongation in at-risk patients 6
   • Mental health: carries boxed warning for suicidal ideation/behavior 1

Alternative Approaches

1. For ADHD management:

   • Consider other non-stimulant options like atomoxetine if phosphate binding is needed
   • Evaluate stimulant medications if not contraindicated

2. For phosphate binding (if applicable):

   • Consider calcium-based phosphate binders instead of aluminum-containing products 3
   • Other non-aluminum phosphate binders may be appropriate

Conclusion

The combination of alum (aluminum hydroxide) and Qelbree (viloxazine) presents significant concerns due to the strong CYP1A2 inhibition by viloxazine and the potential for aluminum toxicity. The safest approach is to avoid this combination and consider alternative treatments for either condition.