Traditionally, stimulant medications such as Ritalin and Adderall have formed the cornerstone of ADHD treatment. However, non-stimulants are increasingly employed as an alternative, particularly for those who respond inadequately to stimulants or experience intolerable side effects.
Qelbree and Strattera are two prominent non-stimulant pharmaceuticals approved by the FDA for treating ADHD. But what precisely are these medications and how do they compare? This exhaustive guide examines every essential facet regarding employing Qelbree versus Strattera for ADHD management.
Stimulants vs. Non-Stimulants for ADHD
Stimulants such as methylphenidate (Ritalin, Concerta) and amphetamines (Adderall, Vyvanse) have traditionally been the first-line pharmacological treatments for ADHD. They work by increasing levels of dopamine and norepinephrine in the brain, which are neurotransmitters involved in attention, focus, and impulse control. For many patients with ADHD, stimulants can provide significant relief from symptoms of inattention, hyperactivity, and impulsivity. They tend to work quickly, often within 30 to 60 minutes, and benefits last for several hours. This makes stimulants very effective for use during school or work hours.
However, stimulants do have some downsides. Up to 30% of people with ADHD may not respond well to stimulant therapy alone. Others find the side effects intolerable, which can include appetite suppression, headaches, anxiety, irritability, and sleep difficulties. There are also concerns about the potential for stimulant misuse and abuse, given that they can cause euphoria at higher doses. Patients with a personal or family history of substance abuse may do better with non-stimulant medications. Additionally, stimulants are Schedule II drugs, meaning extra precautions need to be taken when prescribing.
This is why non-stimulant medications like Strattera and Qelbree can be preferable alternatives in many cases. The mechanisms of non-stimulants are different, targeting neurotransmitters like norepinephrine rather than directly affecting dopamine. While they may not provide the rapid onset of effect like stimulants, non-stimulants provide longer-lasting symptom improvement without the "highs and lows". They have a lower risk of abuse and dependence. Non-stimulants can be the optimal first-line treatment for patients who have comorbid anxiety, tics, substance use disorders, or sleep disturbances. They are also safer options for patients with cardiovascular concerns like high blood pressure or heart defects.
Overall, non-stimulant medications tend to have fewer drug interactions and milder side effect profiles relative to stimulants. While stimulants still play an important role in managing ADHD for many, non-stimulants have emerged as viable alternatives, especially for those who cannot tolerate stimulant side effects, need longer medication coverage, or wish to avoid controlled substances. With options like Qelbree and Strattera now available, doctors can tailor ADHD treatment plans based on each patient's unique needs and clinical profile.
Why Did My Doctor Prescribe Non-Stimulants Instead of Stimulants?
There are several key reasons why your doctor may have decided to prescribe a non-stimulant medication like Qelbree or Strattera, rather than opting for a traditional stimulant like Ritalin or Adderall:
● If you have experienced intolerable side effects from stimulant medications in the past, such as increased heart rate, blood pressure, anxiety, irritability, or sleep disturbances, your doctor will likely avoid prescribing a stimulant again. The milder side effect profiles of non-stimulants make them safer options in these cases.
● If you have a personal or family history of substance abuse or addiction, stimulant medications may not be preferred due to their higher potential for misuse and abuse. Non-stimulants have a much lower risk of abuse, dependence, and diversion.
● If your ADHD symptoms were not adequately controlled by previous trials of stimulant medications, adding a non-stimulant could provide additional benefits and better symptom management. The different mechanisms of non-stimulants can help in stimulant-resistant ADHD.
● If you require medication with a longer duration of action to provide coverage through the day and evening, the around-the-clock efficacy of non-stimulants makes them preferable. Stimulants usually wear off after 4-6 hours.
● If you have any comorbid conditions where stimulant use may be risky or contraindicated, such as heart defects, hypertension, glaucoma, or Tourette's syndrome, non-stimulants are the safer choice. They do not exacerbate comorbidities as stimulants potentially can.
● To avoid common stimulant side effects like appetite/weight loss and sleep disruption which can significantly impact quality of life, especially for growing kids. The milder profiles of non-stimulants are preferred here.
● Some patients wish to try non-stimulant medications first, before considering stimulants. The non-addictive nature and gentler effects of non-stimulants make this a reasonable approach.
In summary, non-stimulants provide a safer, less abusable, and well-tolerated alternative to stimulants for many patients requiring pharmacotherapy for ADHD management. Your doctor likely made this prescription choice with your specific health history and needs in mind.
What Is the Best Non-Stimulant ADHD Medication for Adults or Children?
Determining the optimal non-stimulant ADHD medication for a patient depends on carefully evaluating individual factors such as age, symptom profile, comorbid conditions, side effect risks, and patient/provider preferences.
●For adults, Strattera (atomoxetine) stands out as one of the most well-studied non-stimulant options, with over a decade of use demonstrating its efficacy and safety in treating adult ADHD. Its once or twice-daily dosing provides convenient coverage and compliance.
●For children and adolescents, Strattera is also a frontline choice given its approval for ages 6 and up. However, Intuniv (guanfacine) may be preferable for some pediatric patients given its record of efficacy in children as young as 6 while also having a more favorable side effect profile compared to stimulants.
●The newest non-stimulant, Qelbree (viloxazine), was approved in 2021 for patients ages 6-17 based on placebo-controlled trials showing significant improvement in ADHD symptoms. Its once-daily dosing offers added convenience.
●For adults unable to use Strattera, Kapvay (clonidine) is an alpha-agonist used off-label that shows promise in controlling ADHD symptoms in adults based on smaller studies. More research is still needed on its efficacy.
The right individual choice weighs the patient’s symptom presentation, age, how well the medication treats specific ADHD subtypes, risks of side effects, comorbidities, and individual patient preferences. Those with anxiety may benefit more from certain options, while those needing around-the-clock coverage would require longer-acting agents. Having multiple non-stimulant options allows doctors to tailor treatment plans to each patient's needs. But Strattera and Qelbree remain at the forefront of evidence-based non-stimulant prescribing recommendations for both adults and youth with ADHD.
Qelbree vs. Strattera: Mechanism of Action
Qelbree and Strattera share some similarities in their mechanisms of action as non-stimulant medications for treating ADHD but also have some important differences.
Qelbree contains the active agent viloxazine, which exerts its effects as a selective norepinephrine reuptake inhibitor (NRI). It works by binding to and blocking the norepinephrine transporters in the brain, which leads to increased extracellular concentrations of norepinephrine. This boost in norepinephrine transmission is thought to improve symptoms like attention, focus, and distractibility in ADHD. Importantly, viloxazine does not appear to affect dopamine or serotonin pathways, making Qelbree highly specific for modulating norepinephrine signaling.
Strattera contains the active ingredient atomoxetine, which acts as a selective SNRI. Like viloxazine, atomoxetine blocks norepinephrine transporters to increase levels of this neurotransmitter. However, atomoxetine also weakly inhibits the reuptake of serotonin in addition to norepinephrine, making it less selective. Both medications ultimately enhance noradrenergic neurotransmission, which helps control ADHD symptoms. But only Strattera affects serotonin pathways.
This difference in selectivity may give Qelbree a more targeted mechanism and reduced side effect profile compared to Strattera. viloxazine is specific for norepinephrine reuptake inhibition while atomoxetine has additional serotonergic effects. However, head-to-head comparison studies are still needed to investigate potential differences emerging from the unique mechanisms.
Qelbree vs. Strattera: Drug Interactions
When it comes to drug interactions, there are some overlaps as well as distinct interactions to keep in mind for each medication:
● Both Qelbree and Strattera are contraindicated for use with MAO inhibitors, as the combined effect on norepinephrine levels could lead to dangerous elevations in blood pressure.
● Taking either medication with strong CYP2D6 enzyme inhibitors can significantly increase plasma concentrations, requiring dosage adjustments.
● Strattera specifically interacts with drugs that prolong QT interval, like albuterol and certain NSAIDs. Viloxazine does not appear to carry this interaction risk.
● Qelbree is not recommended with CNS depressants including sedatives, tranquilizers, and alcohol due to risks of additive central nervous system effects.
Overall, the mechanisms differ in terms of selectivity and serotonin effects, which could translate to slight differences in efficacy, tolerability, and interacting medications. However, both act as norepinephrine reuptake inhibitors that enhance NE neurotransmission as their primary mechanism for ADHD treatment.
Qelbree vs. Strattera: Dosage and Administration
For Strattera, dosing usually begins at 40 mg per day for adults, which can be upped to a target dosage of approximately 80 mg per day after at least three days. Depending on tolerability and clinical effect, some patients may require a further dose increase to the maximum of 100 mg per day. For children and adolescents weighing less than 70 kg, the initial dose is often 0.5 mg/kg, with a target dose of 1.2 mg/kg per day, again depending on response and tolerability.
In contrast, Qelbree’s dosing regimen is markedly different. For pediatric patients aged 6 to 11 years, the recommended starting dose is 100 mg daily, increased after one week to a target dose of 200 mg daily based on efficacy and tolerability. For adolescents aged 12 to 17 years, the recommended initial dose is 200 mg daily, which can be increased after one week to a target dose of 400 mg daily, contingent upon patient response and tolerability.
It's also noteworthy that Strattera doses are generally administered once daily or divided into two doses — one in the early morning and another in the late afternoon or early evening. Qelbree, however, is typically administered as a single daily dose.
So while both medications follow a titration schedule, the starting doses, target doses, and the speed at which those doses are escalated differ substantially. Strattera’s dosage is often calibrated based on weight for pediatric patients, while Qelbree’s dosages are age-dependent. These variations make it essential for healthcare providers to monitor patient response and adjust dosages accordingly to ensure optimal efficacy while minimizing side effects.
Qelbree vs. Strattera: Effectiveness
Qelbree is renowned for its swift action, commonly exhibiting obvious improvements to ADHD symptoms within the initial one to two weeks. This rapid response proves particularly helpful for young people currently facing academic or social challenges due to their condition. However, it is prudent to note that Qelbree's efficacy may diverge noticeably between individuals according to factors such as age, symptom severity and additional medical ailments. Consequently, doctors may need to regulate dosage or try combining treatments to attain optimal results. Also important to acknowledge is that Qelbree is chiefly licensed for pediatric usage, with efficacy in adults less well researched.
In contrast, Strattera has a slower onset of action. Patients may require up to six weeks to experience complete therapeutic benefits. This more gradual onset necessarily means maintaining the regimen consistently over an extended phase before appraising suitability. Strattera is indicated for ADHD treatment in both children and adults, rendering it a flexible option. Diverse clinical tests corroborate its enduring efficacy, typically as part of prolonged management plans. Strattera also benefits individuals exhibiting lackluster response to stimulants or seeking a non-stimulant option for sustained symptoms relief.
Qelbree vs. Strattera: Side Effects
Common side effects of Qelbree include:
● Headache
● Decreased appetite
● Nausea
● Fatigue
● Abdominal pain
● Vomiting
● Insomnia
● Dizziness
Common side effects of Strattera include:
● Nausea
● Decreased appetite
● Dizziness
● Fatigue
● Abdominal pain
● Dry mouth
● Erectile dysfunction
● Constipation
● Insomnia
Serious side effects:
Both medications carry warnings about increased risk of suicidal thoughts and behavior in children and adolescents. Patients should be monitored closely.
Strattera use has also been associated with slightly increased heart rate and blood pressure. Hepatic injury is a rare but potential risk.
Given that Qelbree is new, long-term safety still needs further study. But no serious concerns have emerged from clinical trials so far.
Conclusion
In conclusion, both Qelbree and Strattera are beneficial non-stimulant medications proven effective for relieving ADHD symptoms in pediatric and adult patients. For patients starting non-stimulant therapy, either medication can be an excellent option alongside behavioral interventions. The choice between Qelbree and Strattera may come down to insurance coverage and individual patient factors. For example, Qelbree’s once-daily administration could make it preferable for some. More importantly, work closely with your healthcare provider to determine if Qelbree or Strattera is the right non-stimulant medication choice for your ADHD treatment needs.
