Viloxazine ($ Qelbree)

Antidepressant structure (norepinephrine reuptake inhibitor)

  • ADHD2
  • Approved for depression outside the US
  • Depression in alcohol use disorder3
  • Narcolepsy
  • Avoid in bipolar (antidepressant)

Features

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Handout

Dosing

Start 100-200 mg daily, raise every week. Max 400 mg/d (peds) 600 mg/d (adults). Start higher if over age 12.

INTERACTIONS: Strong CYP1A2 inhibitor. Metabolized by CYP2D6, UGT1A9, UGTB15; half life: 7 hours.

Management

A noradrenergic antidepressant used from 1970-2000 in Europe, but fell off the market due to poor sales, then reborn as ADHD treatment in XR form. About half as effective as stimulants and similar efficacy to atomoxetine. Benefits build up over 4 weeks.

TOLERABILITY: Fatigue, decreased appetite, nausea, insomnia, irritability.

RISKS: Hypertension, mania.

EMR Text

ADHD

Viloxazine (Qelbree) use based on FDA approval in ADHD.

Viloxazine side effects reviewed with patient.

Depression

Viloxazine (Qelbree) use based on randomized controlled trials in depression (for which is is approved outside the US).

Viloxazine side effects reviewed with patient.

Depression in Alcohol Use Disorder

Viloxazine (Qelbree) use based on a randomized controlled trial where it improved depression in patients with alcohol use disorder.

Viloxazine side effects reviewed with patient.

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