How can I switch from Qelbree (viloxazine) to Adderall (amphetamine and dextroamphetamine)?

Switching from Qelbree (Viloxazine) to Adderall (Amphetamine/Dextroamphetamine)

To safely switch from Qelbree to Adderall, you should gradually taper off Qelbree over 1-2 weeks while starting Adderall at a low dose of 10 mg once daily, then increasing by 5 mg weekly as needed under medical supervision.

Discontinuation of Qelbree (Viloxazine)

• Qelbree is a nonstimulant selective norepinephrine reuptake inhibitor with activity in both noradrenergic and serotonergic pathways 1
• Unlike stimulants, Qelbree has a decreased risk of substance abuse and dependence 1
• Taper Qelbree gradually rather than stopping abruptly to minimize potential discontinuation effects:
  • If taking 200 mg: Reduce to 100 mg for 3-4 days, then discontinue
  • If taking 400 mg: Reduce to 200 mg for 3-4 days, then 100 mg for 3-4 days, then discontinue
  • If taking 600 mg: Reduce to 400 mg for 3-4 days, then 200 mg for 3-4 days, then 100 mg for 3-4 days, then discontinue 2

Starting Adderall

• Begin with a low dose of Adderall, typically 10 mg once daily in the morning 3
• Titrate by increasing the dose by 5 mg weekly based on response and tolerability 3
• Maximum recommended daily dose is 50 mg for adults 3
• Administer in the morning to minimize sleep disturbances 3

Timing Considerations

• Option 1 (Cross-titration): Begin Adderall at 10 mg once daily when Qelbree is at its lowest taper dose (100 mg)
• Option 2 (Sequential): Complete Qelbree taper first, then start Adderall 2-3 days after the last Qelbree dose
• Option 1 is generally preferred to maintain symptom control during the transition 3

Monitoring During Transition

• Monitor vital signs (blood pressure and pulse) at baseline and with each dose adjustment 3
• Watch for side effects of Adderall, which may include:
  • Increased heart rate and blood pressure
  • Decreased appetite
  • Insomnia
  • Anxiety or irritability
  • Headache 4, 5
• Be alert for potential drug interactions if taking other medications 3

Important Considerations

• Adderall is a Schedule II controlled substance with higher potential for abuse compared to Qelbree 5
• Adderall works through a different mechanism than Qelbree - it acts as a substrate for monoamine transporters, especially dopamine transporters, increasing extracellular dopamine, norepinephrine, and serotonin 4
• The therapeutic effects of Adderall may be noticed more quickly than with Qelbree 1

Common Pitfalls to Avoid

• Starting Adderall at too high a dose, which can lead to unnecessary side effects 3
• Not allowing sufficient time (at least one week) between dose increases to evaluate response 3
• Failing to take Adderall in the morning, which can exacerbate sleep disturbances 3
• Not maintaining regular follow-up appointments during the transition period 3

When to Contact Your Healthcare Provider

• If you experience severe side effects such as chest pain, shortness of breath, fainting, or severe headache 4, 5
• If ADHD symptoms worsen significantly during the transition 3
• If you develop new psychiatric symptoms such as hallucinations, delusions, or mania 4

Remember that this medication switch should always be supervised by your healthcare provider who can personalize the transition plan based on your specific needs and medical history.