Viloxazine (Qelbree)

What it treats

Viloxazine is approved by the U.S. Food and Drug Administration for ADHD in children (age 6 and older), adolescents, and adults. It sits alongside atomoxetine, guanfacine, and clonidine as the non-stimulant options.

Typical situations where viloxazine gets chosen: a patient who can't take a stimulant (misuse concern, cardiac risk, prior bad reaction), a patient who wants a non-controlled option, or an add-on when a stimulant covers part of the day and additional coverage is needed.

How it works

Viloxazine primarily blocks the reuptake of norepinephrine, raising its level in the brain regions involved in attention and impulse control. It also modestly influences serotonin, both as a 5-HT2C receptor partial agonist and as a 5-HT2B antagonist, which is why some people describe a mild mood-lifting or motivational effect on top of the ADHD benefit.

Unlike stimulants, viloxazine doesn't work the same day. Benefit builds over 1 to 4 weeks.

Receptor mechanism (detail)

Viloxazine is a norepinephrine reuptake inhibitor at NET with additional 5-HT2B antagonism and 5-HT2C partial agonism. That receptor combination is different from atomoxetine (pure NET inhibitor) and is one theoretical reason for its faster onset of benefit and its distinct side-effect profile.

Potency and typical dosing pattern

Ranges are typical framework only, not a prescription for any individual.

Children (6 to 11): 100 mg once daily starting, titrated weekly to 200 mg, then 400 mg if needed. Adolescents (12 to 17): 200 mg once daily starting, titrated weekly to 400 mg. Adults: 200 mg once daily starting, titrated weekly to 400 mg, up to 600 mg.

Half-life is about 7 hours; steady state within a few days. Clinical benefit builds over 1 to 4 weeks.

Safety monitoring

• Suicidal thoughts and behaviors. Boxed warning for pediatric patients. New or worsening mood changes, agitation, or suicidal thoughts warrant urgent prescriber contact.
• Blood pressure and heart rate. Baseline and periodic. Viloxazine can modestly raise both.
• Somnolence. Common at initiation.
• Do not combine with MAOIs or use within 14 days of stopping an MAOI.
• Do not open or crush extended-release capsules unless directed. The bead-based capsule can be opened and sprinkled on soft food per the label.

What to expect

Common side effects

• Somnolence and fatigue.
• Reduced appetite.
• Headache.
• Nausea and vomiting.
• Insomnia (paradoxical, uncommon).
• Irritability.

If a side effect is bothersome or persistent, that's a conversation for the prescriber.

Serious side effects and warnings

Boxed warning: suicidal thoughts and behaviors in pediatric patients. Viloxazine, like other medications acting on brain monoamines, carries this class-level warning. New or worsening mood changes, agitation, hostility, or thoughts of self-harm warrant urgent prescriber contact, particularly in the first weeks of treatment and after dose changes.

• Serotonin syndrome when combined with other serotonergic drugs (SSRIs, SNRIs, MAOIs, tramadol, triptans). Symptoms include agitation, tremor, sweating, muscle twitching, high fever.
• Elevated blood pressure and heart rate. Modest but real. Monitor.
• Mania activation. In patients with bipolar disorder or a family history, viloxazine can trigger mania. Assess before starting.
• Somnolence affecting driving or school.

Sexual side effects

Viloxazine hasn't been strongly associated with sexual side effects in adult trials. If a change occurs, mention it to a prescriber.

Weight, appetite, and sleep

Reduced appetite and modest weight loss are common but usually less pronounced than with stimulants. Sleep can be affected in either direction: sedation early on, occasional insomnia later.

Starting and dosing basics

This section is general background, not a dosing instruction for any individual. The right dose is a decision for a prescriber.

Viloxazine comes as extended-release capsules in 100, 150, and 200 mg strengths. Once-daily dosing. Capsules can be opened and sprinkled on soft food if needed.

Missed doses and interactions

If a dose is missed, take it when remembered unless it's close to the next day's dose. Don't double up.

Viloxazine is a strong CYP1A2 inhibitor. That means it raises levels of medications metabolized by CYP1A2, including caffeine, theophylline, tizanidine, and duloxetine. Some of those interactions require dose adjustment; some (tizanidine) are effectively contraindicated.

Do not combine with MAOIs. Combining with SSRIs, SNRIs, tramadol, or triptans raises serotonin syndrome risk. Give every prescriber and pharmacist the full medication list.

Stopping and tapering

Viloxazine doesn't require a strict taper the way antidepressants or benzodiazepines can. Coordinating stopping with a prescriber is still the safer path, and ADHD symptoms are likely to return.

Pregnancy and breastfeeding

Data are limited. Individual circumstances matter, and the decision belongs with a clinician. Anyone pregnant, planning a pregnancy, or breastfeeding should discuss it with their prescriber.

Cost and generic availability

Viloxazine is a newer, branded medication and is not yet available as a generic. Cost is substantial. Insurance coverage is common with prior authorization. The manufacturer offers copay assistance for eligible patients.

Common questions

How is Qelbree different from Strattera (atomoxetine)? Both are non-stimulant, non-controlled, once-daily options that act on norepinephrine. Viloxazine also acts on serotonin at two receptor subtypes, which may contribute to a somewhat faster onset of benefit and a slightly different side-effect profile. In practice, either can be a reasonable choice.

Is it a controlled substance? No. Viloxazine is not a controlled substance and can be refilled the usual way.

How fast does it work? Faster than atomoxetine for some patients. Some effect often shows in 1 to 2 weeks, with clearer benefit by week 4.

Why the suicidal thoughts warning? It's a class-level warning that applies to many medications acting on brain monoamines, particularly in patients under 25. Rates of new suicidal thoughts are low but not zero, and monitoring during initiation and dose changes matters.

Can it be combined with a stimulant? Yes, in some cases, when a prescriber determines the combination is warranted.

Questions to ask your prescriber

• Is viloxazine the right non-stimulant for my (or my child's) situation?
• How will we monitor mood, especially during the first weeks?
• How will we monitor blood pressure and heart rate?
• Which of my (or my child's) other medications interact with viloxazine?
• If we ever stop it, how do we do that?

Sources

This guide draws on current prescribing information and public health references and current as of June 8, 2026. It is reviewed for clinical accuracy and updated as guidance changes.

• U.S. Food and Drug Administration. Viloxazine (Qelbree) prescribing information.
• MedlinePlus, U.S. National Library of Medicine. Viloxazine.
• American Academy of Pediatrics. ADHD Clinical Practice Guideline.
• American Psychiatric Association. Practice guidance on ADHD in adults.