Which systemic or inhaled corticosteroids are safe to co‑prescribe with Qelbree (viloxazine)?

Corticosteroid Safety with Qelbree (Viloxazine)

All systemic and inhaled corticosteroids are safe to co-prescribe with Qelbree (viloxazine), as there are no documented drug interactions between viloxazine and any corticosteroid formulation.

No Known Drug Interactions

• Viloxazine extended-release is a serotonin-norepinephrine modulating agent with a distinct mechanism of action that does not involve cytochrome P450 enzyme inhibition or induction that would affect corticosteroid metabolism 1, 2
• The clinical trial safety databases for viloxazine in both pediatric and adult populations did not identify any contraindications or precautions regarding concurrent corticosteroid use 1, 3, 4
• Long-term safety studies of viloxazine (mean exposure 265 days) demonstrated no new safety signals or drug-drug interactions that would preclude corticosteroid co-administration 1

Specific Corticosteroid Options

Inhaled Corticosteroids (ICS)

• Low-dose ICS formulations such as fluticasone propionate 100-250 mcg/day, budesonide 200-400 mcg/day, or beclomethasone 200-500 mcg/day can be safely prescribed alongside viloxazine for patients with comorbid asthma 5, 6
• Medium-to-high dose ICS including fluticasone up to 500 mcg/day or budesonide up to 800 mcg/day are also safe to combine with viloxazine 7
• ICS/LABA combination inhalers (e.g., fluticasone/salmeterol, budesonide/formoterol) carry no additional interaction risk with viloxazine beyond the standard LABA safety warnings unrelated to viloxazine 5, 7

Systemic Corticosteroids

• Oral corticosteroids such as prednisone, prednisolone, or methylprednisolone used for asthma exacerbations or other indications can be safely co-administered with viloxazine 8
• Intravenous corticosteroids including hydrocortisone or methylprednisolone have no documented interactions with viloxazine 7

Clinical Monitoring Considerations

• The primary adverse effects of viloxazine—insomnia (13.8%), nausea (13.8%), headache (10.7%), and fatigue (10.1%)—are unrelated to corticosteroid pharmacology and do not overlap with typical corticosteroid side effects 1
• Viloxazine carries a boxed warning for suicidal ideation/behavior, which requires monitoring independent of any corticosteroid therapy 3, 9
• When prescribing ICS with viloxazine, standard asthma management principles apply: verify proper inhaler technique, rinse mouth after ICS use to reduce local side effects, and use spacers with metered-dose inhalers 5, 6

Common Pitfall to Avoid

• Do not withhold necessary corticosteroid therapy in patients taking viloxazine based on unfounded concerns about drug interactions—there is no pharmacological basis for such restriction 1, 2