Which medications in the drug class Norepinephrine Reuptake Inhibitors, Selective are used in the treatment of Pediatric Attention Deficit Hyperactivity Disorder (ADHD)?

Updated: Sep 09, 2021
  • Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD  more...
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Norepinephrine Reuptake Inhibitors, Selective

Nonstimulant options for ADHD treatment are available. 

Viloxazine (Qelbree)

The mechanism of action by which viloxazine affects ADHD is unclear; however, it may be by selectively inhibiting norepinephrine reuptake. Indicated for treatment of ADHD in children and adolescents aged 6-17 years.

Atomoxetine (Strattera)

SNRI that inhibits presynaptic norepinephrine transporter. Also appears to indirectly stimulant dopamine activity in frontal lobes. Many anecdotal reports state that, when stimulants are not well-tolerated at a dose necessary for efficacy (eg, because of anxiety) and atomoxetine is not efficacious enough alone, the combination of atomoxetine and low dose (tolerable) stimulants is often very effective.

About 5-10% of patients are poor metabolizers of the drug and have increased drug exposure, peak serum levels, and half-lives. If intolerable but benign adverse effects are present at FDA-recommended doses, but not at lower dose, efficacy may be observed at the lower dose; therefore consider a low-dose trial. Usually clinically effective qd despite 5-h half-life (24 h in poor metabolizers); unknown if serum levels are correlated with efficacy.

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