Viloxazine: Difference between revisions

(7 intermediate revisions by 2 users not shown)

Line 1:

{{MedTemplate

~~| generic = Viloxazine~~

| brand = Qelbree

| classes = Selective norepinephrine reuptake inhibitor (NRI) with 5HT1A partial agonism, non-stimulant ADHD agent

~~| structure =~~

| mechanism = Selective NET inhibitor (no significant DAT activity, distinguishes from amphetamine/methylphenidate). Also: 5HT1A receptor partial agonism, 5HT2B and 5HT7 receptor antagonism. The serotonergic actions may underlie better tolerability and possibly different efficacy spectrum than atomoxetine.

| classes = NRI, ADHD ~~medicine~~

| uses = ADHD in children (6+), adolescents, and adults (FDA-approved 2021 for pediatric, 2022 for adult)

| mechanism = Selective ~~norepinephrine reuptake~~ inhibitor

| starting_dose = Pediatric 6-11: 100 mg PO daily, titrate weekly to max 400 mg. Adolescent 12-17: 200 mg, max 400 mg. Adult: 200 mg, max 600 mg.

| uses =

| preparations = 100 mg, 150 mg, 200 mg extended-release capsules (can be sprinkled on food)

| starting_dose =

| fda_max = 400 mg/d (pediatric); 600 mg/d (adult)

| preparations =

| routes = Oral

| fda_max =

| onset = ADHD symptom improvement reported within 1-2 weeks (faster than atomoxetine which takes 4-6 weeks)

| routes =

| duration = Daily dosing

| onset =

| halflife = ~7 hours

| duration =

| bioavailability = Adequate oral bioavailability with extended-release formulation

| halflife =

| pregnancy = Limited data

| bioavailability =

| legal = Rx, '''not a controlled substance''' (no DEA scheduling)

| pregnancy =

| intro = '''Viloxazine''' (brand name Qelbree) is an extended-release norepinephrine reuptake inhibitor FDA-approved in 2021 for ADHD in children 6 and older, and in 2022 for adults. Originally developed as an antidepressant in Europe in the 1970s (withdrawn for commercial reasons), it was repurposed for ADHD. Like atomoxetine, viloxazine is a non-stimulant alternative that is '''not a controlled substance'''. However, viloxazine has a more complex pharmacology than atomoxetine, beyond pure NET inhibition, it has 5HT1A partial agonism and 5HT2B/5HT7 antagonism, which may underlie faster onset (1-2 weeks vs atomoxetine's 4-6 weeks) and possibly different efficacy.

| legal =

| intro =

Useful when stimulants are contraindicated, undesirable, or insufficient. Can be combined with stimulants.

~~| pharmacokinetics =~~

| pharmacodynamics= Selective NET inhibition (Ki ~155 nM). 5HT1A partial agonism, 5HT2B antagonism, 5HT2C inverse agonism, 5HT7 antagonism. Minimal DAT activity (key differentiator from stimulants).

| pharmacodynamics =

| effects = Somnolence (most common), decreased appetite, headache, insomnia, fatigue, nausea, irritability. Generally good tolerability. Boxed warning: suicidal ideation in pediatric patients (class warning for SNRIs/antidepressants used in pediatric ADHD).

~~| indications =~~

| interactions = <pharmaInteractions/>

~~| dosing~~ =

| effects =

| interactions = <pharmaInteractions/>

~~| pregnancy_details =~~

~~| monitoring =~~

~~| counseling =~~

~~| anecdotes =~~

~~| seealso =~~

~~| references =~~

}}

[[Category:Norepinephrine Reuptake Inhibitors (NRIs)]]

[[Category:~~Stimulants & Wake-Promoting Agents~~]]

[[Category:Antidepressants]]

[[Category:~~Psychostimulants~~]]

[[Category:Non-stimulant ADHD Medicines]]

MDElliottMD (talk | contribs)