Patient Education on Viloxazine (Qelbree)
How Viloxazine Works
Viloxazine is a serotonin-norepinephrine modulating agent that works differently from stimulants by increasing both norepinephrine and serotonin levels in the brain's prefrontal cortex, which helps regulate attention, impulse control, and emotional responses. 1, 2
- Primary mechanism: Viloxazine blocks the reuptake of norepinephrine (a brain chemical involved in attention and alertness) while also modulating serotonin activity, particularly at 5-HT2C receptors 1, 2
- Key difference from other medications: Unlike atomoxetine (which only affects norepinephrine) or stimulants (which primarily affect dopamine), viloxazine has this dual serotonin-norepinephrine action that makes it mechanistically unique 1, 3
- Non-stimulant classification: It does not increase dopamine in the brain's reward centers the way stimulants do, which means lower risk of abuse, dependence, or withdrawal 4
Which ADHD Symptoms It Treats Best
Viloxazine effectively reduces all core ADHD symptoms—inattention, hyperactivity, and impulsivity—with benefits typically appearing within 1-2 weeks, though full effects may take 2-4 weeks. 3, 5
Core Symptom Improvement:
- Inattention symptoms: Difficulty focusing, completing tasks, organizing activities 6, 5
- Hyperactivity symptoms: Excessive fidgeting, inability to stay seated, restlessness 6, 5
- Impulsivity symptoms: Interrupting others, difficulty waiting turns, acting without thinking 6, 5
Additional Benefits:
- Morning and evening symptom control: Studies show improvement in ADHD behaviors throughout the entire day, regardless of whether taken in morning or evening 7
- Executive function improvement: Better planning, organization, and decision-making abilities 8
- Quality of life enhancement: Sustained improvements in daily functioning over long-term use 8
- Potential mood benefits: May be particularly helpful for patients with comorbid depression, given its serotonin activity 6
Practical Information for Patients
Dosing and Administration:
- Starting dose: Typically 200 mg once daily in the morning 1, 3
- Dose adjustments: Can be increased by 200 mg weekly based on response, up to maximum 600 mg/day 1
- Timing flexibility: Can be taken morning or evening based on individual needs and side effect profile 7
- Onset of action: Faster than atomoxetine (1-2 weeks vs. 4 weeks), though slower than stimulants 5
Common Side Effects to Expect:
- Gastrointestinal: Nausea, vomiting, abdominal discomfort, diarrhea (most common) 1
- Appetite/weight: Decreased appetite and weight loss 1
- Sleep-related: Either insomnia or somnolence can occur 1, 8
- General: Headache, fatigue, dizziness, dry mouth 1, 8
- Cardiovascular: Mild increases in blood pressure and pulse 1
Important Safety Warnings:
- Suicidal thinking risk: Like other antidepressants, carries a black box warning for increased risk of suicidal thoughts in patients up to age 24—requires close monitoring, especially when starting or changing doses 1, 5
- Serotonin syndrome risk: Avoid combining with other serotonergic medications (certain antidepressants, migraine medications) without medical supervision, particularly in first 24-48 hours after starting 1, 2
- Pregnancy/breastfeeding: Limited safety data available; discuss risks and benefits with your doctor 1
When Viloxazine Is Particularly Useful:
- Stimulant non-responders: When methylphenidate or amphetamines don't work or cause intolerable side effects 6, 4
- Substance abuse concerns: No abuse potential, making it safer for patients with addiction history 4
- Comorbid depression: The serotonin activity may provide additional mood benefits 6
- Augmentation therapy: Can be safely combined with stimulants when stimulant alone provides inadequate response 7
Effectiveness Compared to Other Medications:
- Effect size: Approximately 0.7 (similar to atomoxetine and alpha-2 agonists), compared to 1.0 for stimulants 9
- Clinical significance: While slightly less robust than stimulants statistically, many patients achieve excellent symptom control, with 73% of adults using doses of 400 mg or higher during maintenance treatment 8
- Long-term efficacy: Sustained improvement in symptoms over extended use (average 265 days in studies) 8