Switching from Strattera to Qelbree: No Taper Required
Atomoxetine (Strattera) can be discontinued without tapering when switching to viloxazine (Qelbree). 1
Direct FDA Guidance
The FDA-approved prescribing information for atomoxetine explicitly states: "Atomoxetine capsules can be discontinued without being tapered." 1 This is the definitive guidance for this medication and takes precedence over general tapering principles that apply to other psychotropic medications.
Why Atomoxetine is Different
Unlike many other psychotropic medications that act on the central nervous system, atomoxetine does not require gradual dose reduction because:
- It is not associated with significant withdrawal syndromes that necessitate tapering 1
- The medication's pharmacologic profile as a selective norepinephrine reuptake inhibitor does not create the same receptor adaptations that lead to withdrawal symptoms seen with other agents 2, 3
Practical Switching Protocol
When transitioning from Strattera to Qelbree:
- Stop atomoxetine abruptly on the day you plan to start viloxazine 1
- Begin viloxazine at the standard starting dose per its prescribing information (typically 100 mg once daily for adults, with titration based on response and tolerability)
- No overlap or cross-taper period is needed between these two medications 1
Important Caveats
While atomoxetine itself doesn't require tapering, monitor for:
- Return of ADHD symptoms during the transition period, as there will be a gap in therapeutic coverage
- Any individual patient factors that might warrant closer monitoring (though not necessarily tapering), such as comorbid anxiety or mood disorders
- Adequate time for viloxazine to reach therapeutic effect, which may take several weeks
Contrast with Other Medications
This straightforward approach differs markedly from switching between other psychotropic medications:
- SSRIs and SNRIs require gradual tapers (often over 4+ weeks) to minimize withdrawal symptoms 4, 2, 5
- Other CNS-active medications like antipsychotics, benzodiazepines, and opioids necessitate slow, individualized tapers to avoid severe withdrawal 6, 7, 8
- Atomoxetine stands apart with its unique pharmacologic profile that permits abrupt discontinuation 1