How to discontinue Qelbree (Viloxazine)

Discontinuing Qelbree (Viloxazine)

Qelbree can be discontinued without a mandatory taper, as viloxazine has a decreased chance of withdrawal symptoms upon cessation of therapy compared to stimulants and other psychiatric medications. 1

Key Discontinuation Principles

No Required Taper Protocol

• Unlike many psychiatric medications, viloxazine does not have established withdrawal symptoms that necessitate a gradual taper 1
• The medication can be stopped abruptly if clinically indicated, though a gradual approach may still be prudent for monitoring purposes 2
• This represents a significant advantage over stimulants and other ADHD medications that may require more careful discontinuation 1

When to Consider Discontinuation

Stop viloxazine if:

• The patient has not achieved adequate symptom improvement after an appropriate trial period 2
• Intolerable adverse effects develop, particularly insomnia (13.8% incidence), nausea (13.8%), headache (10.7%), or fatigue (10.1%) 3
• Serious adverse effects occur, including behavioral activation/agitation, hypomania, mania, or signs of serotonin syndrome 4
• The patient develops suicidal thinking or behavior (monitor particularly in patients through age 24 years) 4

Practical Discontinuation Approach

If choosing a gradual approach:

• Consider tapering over 1-2 weeks to allow for monitoring of symptom return, though this is based on general psychiatric medication principles rather than specific viloxazine requirements 2
• Monitor for return of ADHD symptoms (hyperactivity, impulsivity, inattentiveness) during and after discontinuation 1
• Extended monitoring may be needed as symptom recurrence can occur weeks after the last dose 2

Important Safety Considerations

Monitor for these specific concerns during discontinuation:

• Cardiovascular parameters (blood pressure and pulse) should be checked, as viloxazine can cause increases in these measures 4
• Watch for mood changes or behavioral symptoms, particularly in younger patients (through age 24) given the suicidal thinking risk 4
• Be alert for serotonin-related symptoms if the patient is on other serotonergic agents, especially within 24-48 hours of stopping 4

Clinical Context

• The lack of significant withdrawal symptoms with viloxazine distinguishes it from traditional antidepressants (which often require tapers over weeks to months) and represents a practical advantage 5, 1
• Viloxazine's mechanism as a serotonin-norepinephrine modulating agent with minimal dopamine effects in the nucleus accumbens contributes to its lower abuse potential and easier discontinuation profile 1
• In long-term studies, 17.6% of participants discontinued due to adverse events, most commonly insomnia, nausea, and fatigue, without reports of significant withdrawal syndromes 3

Post-Discontinuation Planning

• Develop a monitoring plan to assess whether ADHD symptoms return after stopping viloxazine 2
• Consider alternative ADHD treatments if discontinuation is due to lack of efficacy rather than adverse effects 6
• Document the reason for discontinuation and response to help guide future treatment decisions 2