Qelbree (Viloxazine) vs. Strattera (Atomoxetine) for ADHD

Medically reviewed by Alex Yampolsky, PharmDMedically reviewed by Alex Yampolsky, PharmD

Multiple treatment options are available for managing attention-deficit hyperactivity disorder (ADHD), including stimulant and non-stimulant medications. Qelbree (viloxazine) and Strattera (atomoxetine) are two examples of non-stimulant ADHD medications.

Both Qelbree and Strattera are serotonin-norepinephrine reuptake inhibitors (SNRIs). They help increase levels of norepinephrine and serotonin, two chemicals in the brain, to manage ADHD symptoms like impulsivity, inattention, and others.

Though they work similarly, the two have a few differences, particularly in dosing and administration. Unlike Strattera, Qelbree is available in an extended-release (ER) formulation.

Qelbree vs. Strattera: What Are They and What Do They Do?

Qelbree (viloxazine) is a medication that can help manage ADHD symptoms. It belongs to a class of medications called SNRIs. Strattera (atomoxetine) is also an SNRI that can help manage your ADHD.

These medications work in the brain by stopping some of the breakdown of norepinephrine (which helps with learning and memory, attention, and mood) and serotonin (which helps regulate mood, behavior, and attention). Preventing the breakdown of these chemicals helps boost their levels in the brain, which might help manage symptoms.

Stimulant vs. Nonstimulants for ADHD

Stimulants are considered the first-line treatment option for ADHD. They work by affecting the amount of dopamine and norepinephrine in the brain. Examples of medications that are stimulants can include:

• Adderall (dextroamphetamine and amphetamine)

• Vyvanse (lisdexamfetamine)

• Ritalin (methylphenidate)

• Focalin (dexmethylphenidate)

Non-stimulant medications are often taken when stimulants do not work. Unlike stimulants, non-stimulants do not have a risk of misuse and dependency. Examples of non-stimulant medications include:

• Strattera (atomoxetine)

• Qelbree (viloxazine)

• Intuniv (guanfacine)
  

Main Differences and Similarities

The following table compares the main differences and similarities between Strattera and Qelbree.

Which Is More Effective for Treating ADHD?

Both medications have proved better at treating ADHD than a placebo (a medication that looks like a normal tablet or capsule but has no therapeutic effect).

In one small trial of 50 participants, those who switched from treatment with Strattera to Qelbree showed greater improvement in their ADHD symptoms, such as inattention and hyperactivity. However, this study was an open-label opt-in trial, which may have affected the results.

Side Effects

Both medications carry a box warning for a serious risk of increased suicidal thoughts and ideations. Signs of needing to alert you or your child's healthcare provider may include sudden mood or behavioral changes when starting or changing the dose of your medication.

Common side effects of Strattera can include:

• Stomach pain

• Nausea or vomiting

• Tiredness (in adults)

• Loss of hunger

• Dry mouth

• Insomnia (in adults)

• Sexual dysfunction

More rare but severe side effects for Strattera included:

• Liver damage

• Rhabdomyolysis (a rare muscle injury that causes the breakdown of muscle tissue)

• Cardiovascular events, such as heart attack or stroke

• Psychotic or manic symptoms (e.g., hallucinations, delusions)

• High blood pressure

Common side effects of Qelbree include:

• Sleepiness

• Nausea

• Decreased appetite

• Insomnia (in adults)

• Dry mouth (in adults)

• Constipation (in adults)

• Tiredness (in children)

• Loss of appetite

More serious side effects of Qelbree can include:

• Manic episodes in people with bipolar disorder

• High blood pressure

• Increased heart rate

Other Precautions

Do not start Strattera or Qelbree if you have had a hypersensitivity reaction to either medication or their ingredients.

Before starting Qelbree, talk to your healthcare provider about:

• Any kidney problems

• Blood pressure or heart rate problems

• A history of mental health conditions, such as bipolar disorder, or previous suicidal thoughts, ideations, or attempts

• If you are pregnant or plan to become pregnant

• If you are breastfeeding

Before starting Strattera, talk to your healthcare provider about:

• Any liver problems

• If you are pregnant or plan to become pregnant

• If you are breastfeeding

You should not take Strattera if you have or have a history of the following:

• Narrow angle glaucoma

• Pheochromocytoma (a type of neuroendocrine tumor)

• Severe heart disease that might be affected by an increase in heart rate and blood pressure.

Risk of Misuse and Dependence

Because Strattera and Qelbree are non-stimulant medications, their risk for misuse is not commonly compared to other medications taken for ADHD treatment.

Studies have shown that Strattera is not habit-forming compared to a placebo (a drug that has no active ingredient in it). You can abruptly stop taking it if your healthcare provider requests this.

Drug Interactions

Medications broken down in the body by an enzyme called cytochrome 1A2 can stay in your body for longer than intended when taken with Qelbree because Qelbree will make them break down at a slower rate.

Examples of these medications include:

• Theophylline: A medication for managing asthma and chronic obstructive pulmonary disease. If you take theophylline, you may need to adjust your dose when starting Qelbree. Theophylline can carry a high risk of toxicity when taken in too high a dose.

• Lotronex (alosetron): A medication for managing irritable bowel syndrome in women.

• Cymbalta (duloxetine): A medication for managing depression, anxiety, and other mental health conditions.

• Rozerem (ramelteon) and Hetlioz (tasimelteon): Medications that can help regulate sleep and manage insomnia.

• Zanaflex (tizanidine): A medication that can help manage muscle spasms.

If you are taking Strattera, certain medications can cause interactions and unwanted side effects, for example:

• Medications that prevent the breakdown of an enzyme called cytochrome 2D6 can increase the amount of Strattera found in the body because it can cause Strattera to break down at a slower rate. Examples of these medications include Paxil (paroxetine), Prozac (fluoxetine), and quinidine.

• Medications that can alter blood pressure may interact with Strattera.

• Albuterol: Albuterol works by stimulating receptors in the lungs and the heart. Combined with Strattera, it can increase the effect of albuterol on the heart receptors, leading to unwanted side effects.

• Monoamine oxidase inhibitors (MAOIs): If you are taking an MAOI, do not take Qelbree or Strattera at the same time due to the increased risk of severe and possibly fatal cardiovascular events. Before taking Qelbree or Strattera, wait at least 14 days after the last time you took an MAOI before starting your new medication. Examples of MAOIs include isocarboxazid, rasagiline, and selegiline.

How to Find the Right ADHD Medication

Stimulants are commonly prescribed as first-line treatments for ADHD. However, some cases may call for non-stimulants instead, such as:

• If you previously or currently have substance abuse problems or a family history of substance abuse

• If you are trying to avoid the side effects of stimulant medications

• If your stimulant medication is not helping your symptoms

Qelbree and Strattera work similarly, and little research exists on whether one is more effective at managing ADHD. One benefit of Qelbree over Strattera is that the capsule can be opened and the contents sprinkled onto pudding or applesauce, whereas Strattera must be swallowed whole. Therefore, if you or your child have trouble swallowing pills, Qelbree may be a better option.

However, Qelbree has no generic option, so it will likely be more expensive. For this reason, insurance companies may be more likely to cover Strattera before paying for Qelbree.

Summary

Qelbree and Strattera are non-stimulant medications that can help manage your ADHD symptoms without the risk of abuse and dependence like other ADHD medications. They are both SNRIs that are thought to work by targeting certain chemicals in the brain to help regulate behaviors associated with ADHD, like inattention and impulsivity.

Qelbree and Strattera both offer similar benefits in that they are not habit-forming and do not have the same kind of side effects as stimulants. If you can't swallow pills, Qelbree may be preferred because you can open the capsule and consume its contents with food. Insurance coverage may also factor into which medication you take.

Discuss your medication and health history with your healthcare provider to find out if either medication is right for you.

The author would like to thank and recognize Jon Candelaria for contributing to this article.

Read the original article on Verywell Health.