Qulbee vs. Strattera for ADHD: Risks and Benefits Comparison
Strattera (atomoxetine) is generally preferred over Qulbee (viloxazine) for ADHD treatment due to its more established safety profile, extensive clinical evidence, and proven long-term efficacy. 1
Medication Mechanisms and Efficacy
- Strattera (atomoxetine) is a selective norepinephrine reuptake inhibitor that has been FDA-approved for ADHD treatment in both children and adults with an effect size of approximately 0.7 compared to placebo 1
- Qulbee (viloxazine) is a newer non-stimulant medication with limited data on its efficacy in adults and very limited information on its safety profile in various populations 1
- Both medications are non-stimulants and therefore have "around-the-clock" effects rather than the time-limited effects seen with stimulant medications 1
- Atomoxetine has demonstrated continued efficacy in long-term treatment (up to 18 months) in maintaining response in patients who initially responded well 2
- Both medications have smaller effect sizes compared to stimulant medications, which typically have effect sizes around 1.0 1
Safety Profile and Side Effects
Strattera (Atomoxetine)
- Most common side effects include initial somnolence, gastrointestinal symptoms (nausea, decreased appetite), headache, and dry mouth 1, 3
- Rare but serious side effects include increased suicidal thoughts and hepatitis 1
- Generally well tolerated with withdrawal rates due to adverse events of 7.8-9.3% in clinical trials 4
- Has been extensively studied with over 3,000 children and adolescents enrolled in clinical trials, with about 1,200 treated for more than 1 year 2
- Shows fewer effects on growth/height compared to stimulants 1
Qulbee (Viloxazine)
- Limited published information on its safety in pregnancy and breastfeeding 1
- Not currently available in Canada; approved in the United States for treatment in children and adolescents aged 6 and older 1
- Has limited data on its efficacy for treating ADHD in adults 1
- Guidelines suggest caution with its use due to limited safety data 1
Special Considerations
- Neither medication is a controlled substance, making them valuable options for patients with history of substance abuse or those who prefer not to take controlled substances 3, 4
- Atomoxetine can be administered once daily or split into two doses, providing flexibility in dosing 3, 5
- Atomoxetine has been shown to improve quality of life measures including social and family functioning 2
- Treatment effects for atomoxetine are not usually observed until several weeks after initiation (6-12 weeks), unlike stimulants which have more rapid onset 1
- For adolescents at risk of medication misuse, atomoxetine may be preferable as it has negligible abuse potential 1, 6
Treatment Algorithm Based on Patient Factors
First-line treatment for most patients with ADHD:
- Stimulant medications have the strongest evidence for efficacy 1
When non-stimulants are preferred:
For patients with comorbid conditions:
Important Caveats
- The treatment effects of atomoxetine take longer to appear (6-12 weeks) compared to stimulants, so patients need to be counseled about expectations 1
- Regular monitoring of vital signs is recommended with both medications as they can affect heart rate and blood pressure 1
- Neither medication should be abruptly discontinued; gradual tapering is recommended 1
- While atomoxetine has been studied extensively in various populations, viloxazine has significantly less real-world data and long-term safety information 1
In conclusion, when choosing between Qulbee and Strattera for ADHD treatment, Strattera has a more established safety profile, more extensive research supporting its use, and demonstrated long-term efficacy, making it the preferred non-stimulant option for most patients 1, 3, 2.