What is the best way to taper off Qelbree (viloxazine) 200mg in a pediatric patient with Attention Deficit Hyperactivity Disorder (ADHD)?

Tapering Qelbree (Viloxazine) 200mg in Pediatric Patients

Qelbree does not require tapering and can be discontinued abruptly without risk of withdrawal symptoms or rebound effects, unlike alpha-2 agonists such as guanfacine or clonidine. 1

Direct Discontinuation Protocol

• Stop Qelbree 200mg immediately without dose reduction, as viloxazine extended-release has no evidence of withdrawal syndrome, rebound hypertension, or discontinuation effects in clinical trials involving over 1,100 pediatric patients 1
• The safety profile from long-term studies (up to 72 months) demonstrates that 8.2% of patients discontinued due to adverse events, but none required tapering to prevent withdrawal symptoms 1
• This contrasts sharply with alpha-2 agonists like guanfacine, which must be tapered by 1mg every 3-7 days to avoid dangerous rebound hypertension 2, 3

Post-Discontinuation Monitoring

• Monitor for return of ADHD symptoms within 1-2 weeks, as viloxazine's therapeutic effects will dissipate after discontinuation, with most patients experiencing symptom recurrence 1, 4
• Schedule follow-up within 2-4 weeks to assess ADHD symptom severity using standardized rating scales (ADHD-RS-5) and determine if alternative treatment is needed 1
• Watch for potential mood changes or irritability that may emerge as ADHD symptoms return, particularly if the patient had comorbid anxiety or mood symptoms 4

Common Pitfalls to Avoid

• Do not confuse viloxazine with other non-stimulants that require tapering—atomoxetine can be stopped abruptly, but SSRIs (if used for comorbid conditions) require gradual discontinuation to avoid SSRI discontinuation syndrome 3
• Do not taper multiple medications simultaneously if the patient is on combination therapy—complete viloxazine discontinuation first, allow stabilization for 1-2 weeks, then address other medications if needed 3
• Do not assume immediate symptom worsening—viloxazine has a relatively rapid onset (2 weeks for response in 86% of patients), but symptom return after discontinuation may be gradual over several days 5

Alternative Treatment Considerations

• If discontinuing due to inadequate response, consider that 96% of patients switching from atomoxetine to viloxazine preferred viloxazine, suggesting switching to atomoxetine may not be optimal 5
• If discontinuing due to side effects (most commonly somnolence 9.5%, headache 8.9%, or decreased appetite 6.0%), these resolve within days of stopping viloxazine 1
• If transitioning to stimulant therapy, begin the stimulant immediately after stopping viloxazine without washout period, as there are no significant drug interactions 4, 5