Qelbree (Viloxazine) Uptitration Schedule
The recommended uptitration schedule for Qelbree (viloxazine extended-release) is to start at 200 mg once daily and increase by 200 mg increments at weekly intervals based on response and tolerability, with a maximum daily dose of 600 mg. 1
Dosing Guidelines for Different Age Groups
Children (6-11 years)
- Starting dose: 100 mg once daily
- Titration: Increase by 100 mg weekly
- Target dose range: 100-400 mg once daily
- Maximum dose: 400 mg once daily
Adolescents (12-17 years)
- Starting dose: 200 mg once daily
- Titration: Increase by 200 mg weekly
- Target dose range: 200-400 mg once daily
- Maximum dose: 400 mg once daily
Adults
- Starting dose: 200 mg once daily
- Titration: Increase by 200 mg weekly
- Target dose range: 400-600 mg once daily
- Maximum dose: 600 mg once daily
Titration Considerations
- Weekly increments are recommended to allow assessment of response and tolerability before increasing the dose 1
- Most adult patients require doses ≥400 mg/day during maintenance treatment, with approximately 36% requiring the maximum 600 mg/day dose 2
- Clinical effects may be observed as early as 1-2 weeks after initiation, which is faster than some other non-stimulants like atomoxetine (which typically takes ~4 weeks) 3
Monitoring During Titration
Assess for common side effects during titration, including:
- Somnolence/fatigue
- Headache
- Decreased appetite
- Irritability
- Nausea
- Insomnia
Monitor vital signs, particularly blood pressure and heart rate, as Qelbree is a norepinephrine reuptake inhibitor
Special Considerations
- If doses are missed for 1-4 days, viloxazine concentration returns to steady-state levels after approximately 2 days of resuming once-daily dosing 4
- Unlike stimulant medications, viloxazine is a non-stimulant without evidence of drug dependence, making it suitable for patients with concerns about stimulant use 5
- For patients with hepatic impairment, dose adjustments may be necessary due to the drug's metabolism
Efficacy Expectations
- Improvements in ADHD symptoms are typically observed within the first two weeks of treatment 2
- Continued improvement may be seen with ongoing treatment
- Efficacy has been demonstrated for core ADHD symptoms as well as improvements in peer relations and social activities 6
Remember that while this uptitration schedule is recommended based on clinical evidence, monitoring for therapeutic response and adverse effects is essential throughout the titration process.