What is the recommended dosing strategy for Qelbree (viloxazine) 200 mg in patients with Attention Deficit Hyperactivity Disorder (ADHD)?

Qelbree (Viloxazine) 200 mg Dosing Strategy for ADHD

For patients with ADHD, Qelbree (viloxazine) should be initiated at 200 mg once daily for adults and adolescents (12-17 years), with titration in increments of 200 mg weekly to a maximum of 600 mg daily for adults and 400 mg daily for adolescents, based on response and tolerability. 1

Age-Specific Dosing Recommendations

Adults

• Starting dose: 200 mg once daily
• Titration: Increase by 200 mg weekly
• Maximum dose: 600 mg once daily
• Most adults (73%) require maintenance doses ≥400 mg/day 2

Adolescents (12-17 years)

• Starting dose: 200 mg once daily
• Titration: Increase by 200 mg after 1 week
• Maximum dose: 400 mg once daily

Children (6-11 years)

• Starting dose: 100 mg once daily
• Titration: Increase by 100 mg at weekly intervals
• Maximum dose: 400 mg once daily

Administration Guidelines

• Administer orally once daily with or without food 1
• Capsules may be swallowed whole OR opened and sprinkled over applesauce or pudding 1
• When sprinkled, consume within 2 hours for applesauce or 15 minutes for pudding 1, 3
• Do not cut, crush, or chew the capsules 1

Pre-Treatment Assessment

Before initiating Qelbree:

• Assess heart rate and blood pressure 1
• Screen for personal or family history of:
  • Suicide
  • Bipolar disorder
  • Depression 1

Monitoring During Treatment

• Reassess heart rate and blood pressure:
  • After each dose increase
  • Periodically during therapy 1
• Monitor for emergence of suicidal thoughts or behaviors (carries boxed warning) 1, 4
• Watch for common adverse effects:
  • Adults: insomnia, headache, somnolence, fatigue, nausea, decreased appetite 1, 2
  • Pediatric patients: somnolence, decreased appetite, fatigue, nausea, vomiting, insomnia, irritability 1

Special Populations

Patients with Renal Impairment

• Severe impairment (eGFR <30 mL/min/1.73m²):
  • Starting dose: 100 mg once daily
  • Titration: 50-100 mg weekly
  • Maximum dose: 200 mg once daily
• No dosage adjustment needed for mild to moderate renal impairment 1

Mechanism and Clinical Considerations

• Viloxazine is a selective norepinephrine reuptake inhibitor (NRI) 5
• Nonstimulant option with decreased risk of substance abuse compared to stimulants 5
• Onset of action appears faster (1-2 weeks) than atomoxetine (approximately 4 weeks) 4
• May be appropriate when stimulants are contraindicated or not tolerated 5, 4

Important Contraindications

Qelbree is contraindicated in patients:

• Receiving MAO inhibitors or within 14 days of discontinuing an MAOI
• Taking sensitive CYP1A2 substrates or CYP1A2 substrates with narrow therapeutic range 1

Long-Term Treatment

• Periodically reevaluate the need for continued treatment
• Adjust dosage as needed based on ongoing assessment of efficacy and tolerability 1
• Long-term studies show sustained improvement in ADHD symptoms with continued use 2

Common Pitfalls to Avoid

• Failing to screen for suicidality, bipolar disorder, or depression before initiating treatment
• Not monitoring vital signs during dose titration
• Abrupt discontinuation rather than gradual dose reduction
• Overlooking potential drug interactions, particularly with MAOIs and CYP1A2 substrates
• Inadequate dose titration (most adult patients benefit from doses ≥400 mg/day) 2