5 Non-Stimulant ADHD Medications: Strattera, Intuniv, and More
Key takeaways:
Strattera (atomoxetine) and Qelbree (viloxazine) are FDA-approved, non-stimulant ADHD options for adults and kids ages 6 years and older. Strattera is generally considered the most effective non-stimulant ADHD medication, but Qelbree, a newer ADHD medication, works in a similar way.
Intuniv (guanfacine) and Kapvay (clonidine) may be taken alone or in combination with stimulants, such as Adderall (amphetamine salts), for ADHD treatment in children and teens. Off-label medications, such as bupropion and Norpramin (desipramine), can play an important role in adult ADHD treatment.
Non-stimulant medications aren’t always as effective as stimulant medications. But they may be considered if you or your child aren’t responding to stimulants or are experiencing bothersome side effects from them.
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Table of contents
ADHD (attention-deficit hyperactivity disorder) is a complex condition to treat. Thankfully, you have several treatment options to choose from. But narrowing down which options are best suited for you and your symptoms can be a challenge.
Parent Training in Behavior Management (PTBM) is one important step in treating ADHD in children. This is where parents learn skills and strategies to help their kids thrive with ADHD; getting extra support in the classroom is often recommended, too. Stimulant and non-stimulant medications can also be used in combination with behavior therapy, typically in kids ages 6 years and older.
Stimulant medications are first-choice medications for children, adolescents, and adults with ADHD. However, non-stimulant medications tend to be called on when stimulant medications haven’t worked or cause intolerable side effects.
Here, we’ll describe the top five non-stimulant medication options used to treat ADHD.
1. Strattera
Strattera (atomoxetine) is one of the most common non-stimulant ADHD medications. It’s also considered the most effective one. Strattera comes as an oral capsule that can be taken with or without food.
Strattera belongs to a class of medications known as selective norepinephrine reuptake inhibitors (NRIs). NRIs work by increasing the activity of a neurotransmitter (brain chemical) called norepinephrine. While the specific way it works isn’t fully known, Strattera helped address symptoms of inattentiveness and hyperactivity in its initial clinical studies.
The best Strattera dosage for children 6 to 17 years old depends on their body weight. If your child weighs 70 kg (154 lbs) or less, they’ll likely start off by receiving a smaller, weight-based dose. But if they weigh more than 70 kg, they’ll follow adult dosing. The typical adult Strattera starting dose is 40 mg per day. After 3 days, your dose may go up depending on your response to the medication.
While Strattera is beneficial for many people, some side effects are possible. Common side effects of Strattera in children include an upset stomach, decreased appetite, and nausea. Common side effects in adults include constipation, dry mouth, and nausea. Managing Strattera side effects is discussed more in another GoodRx Health article.
Keep in mind: Strattera has a boxed warning — the FDA’s most serious medication warning. Strattera may increase the risk of thoughts of suicide in children and adolescents. This side effect is rare, but it’s important to talk to your child about their feelings and maintain a watchful eye for possible changes in their behavior.
2. Qelbree
Qelbree (viloxazine) is the newest non-stimulant medication for ADHD. It’s an oral capsule that can be taken with or without food. You can swallow it whole or open it up and sprinkle its contents into applesauce or pudding for easier consumption — whichever you prefer.
This NRI medication is approved to treat ADHD in people ages 6 years and older. The recommended Qelbree dosage for children depends on their age. Children younger than 12 years old usually start by taking 100 mg once daily. Adults and children 12 and older start at a dose of 200 mg once daily. The maximum daily Qelbree dosage is 400 mg in children under 18 years of age and 600 mg in adults.
Frequent and expected side effects of Qelbree include sleepiness, decreased appetite, and nausea in children. Insomnia, fatigue, and headache are more common in adults. As Qelbree is taken once a day, you or your child can take it later in the day if you feel sleepy or tired after taking the medication. In turn, if Qelbree makes you feel more awake, you may want to take it earlier in the day.
Similar to Strattera, Qelbree also has a boxed warning for thoughts of suicide. It’s very rare, but sure to be on the lookout for any changes in your child’s behavior and talk to them about their emotions — especially when first starting Qelbree.
3. Intuniv
Intuniv (guanfacine ER) is an oral tablet approved to treat ADHD in children ages 6 to 17. Your child’s healthcare provider may recommend it by itself or in combination with a stimulant medication if they have harder-to-treat ADHD.
Intuniv works differently than Strattera and Qelbree, which might benefit some people. It belongs to a class of medications known as central alpha 2-adrenergic receptor agonists. The exact way that Intuniv works for ADHD isn’t clear though.
The typical starting dose for children and teens is 1 mg once daily. Your child’s healthcare provider may gradually increase their dose over a few weeks to a safe and effective dose. The maximum once-daily dose is 4 mg for children ages 6 to 12. For 13 to 17 year olds, it’s 7 mg. You should avoid giving Intuniv with a high-fat meal, as this can cause Intuniv levels in your blood to increase. This raises the risk of side effects.
Common Intuniv side effects include sleepiness, dizziness, and nausea. More serious side effects include low blood pressure, low heart rate, and fainting. Your child’s healthcare provider will likely monitor your blood pressure and heart rate when you start the medication and periodically thereafter. If your child needs to stop Intuniv, talk with their provider first. They can explain how to stop gradually to avoid dangerous spikes in blood pressure.
4. Kapvay
Kapvay (clonidine ER) is another oral tablet that treats ADHD in kids ages 6 to 17 years old. It’s a centrally-acting alpha 2-adrenergic agonist that can be used alone or in combination with stimulant medications for ADHD. Your child can take it with or without food, too.
Kapvay daily dosages range from 0.1 mg to 0.4 mg. It's usually started as a once-daily 0.1 mg dose at bedtime. Then, if needed, the dose may be increased over time to a larger dosage that’s split between two doses — one in the morning and one in the evening.
Common side effects of Kapvay include sleepiness, constipation, and insomnia. More serious side effects include low blood pressure and low heart rate. And like Intuniv, it’s important to ask your child’s healthcare provider how to lower your child’s dose gradually if they need to stop taking it.
5. Off-label medications
Some medications aren’t officially FDA approved to treat ADHD. But your healthcare provider may recommend them as an off-label treatment, especially if you have other conditions they’re approved to treat — like anxiety or depression.
Some off-label medications used for adults with ADHD include:
These medications might be helpful for some adults with ADHD, but they haven’t been shown to be as effective as more traditional non-stimulant ADHD medications.
How do you know which non-stimulant ADHD medication is right for you or your child?
There isn’t a “one-size-fits-all” medication for ADHD. If you or your child needs something other than a stimulant, the best one will ultimately depend on the response to the medication.
Strattera is considered the most effective non-stimulant ADHD medication by pediatric clinical guidelines. But these guidelines came out before Qelbree was approved for use. And not everyone responds well to Strattera. In cases like these, your healthcare provider may recommend trying another medication. They may even recommend combining two or more different ADHD medications.
Keep in mind: Before switching to a different medication, it’s important to make sure that you or your child are taking your ADHD medication(s) as prescribed. Your healthcare provider may suggest you try a larger dose — up to the maximum recommended and tolerated dose — before prescribing another medication. In some cases, you or your child may experience an intolerable side effect, which may also prompt a change in medication.
When are non-stimulant ADHD medications preferred over stimulants?
Stimulant medications are first-choice treatments for ADHD, generally speaking. The evidence for non-stimulant medications is good, but not as strong as stimulant medications.
This isn’t always the case though. Non-stimulant medications are ideal choices in a few situations. One is when the stimulant medications don’t work; another is if you or your child has intolerable side effects from them.
Stimulant medications also have potential for dependence and misuse. Some people shy away from taking stimulants due to this reason.
The bottom line
Strattera (atomoxetine) is the most well-studied and effective non-stimulant ADHD medication for adults and children ages 6 and older. But Qelbree, a newer ADHD medication, works in a similar way. Intuniv (guanfacine ER) and Kapvay (clonidine ER) are approved for kids ages 6 to 17 and can be used alone or in combination with stimulant medications. And while some medications, like bupropion and venlafaxine, are taken off-label for adults with ADHD, they don’t have extensive supporting evidence.
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References
Children and Adults with Attention-Deficit/Hyperactivity Disorder. (n.d.). Medication management.
Concordia Pharmaceuticals Inc. (2022). Kapvay - clonidine hydrochloride tablet, extended release [package insert].
Eli Lilly and Company. (2022). Strattera- atomoxetine hydrochloride capsule [package insert].
Supernus Pharmaceuticals, Inc. (2022). Qelbree- viloxazine hydrochloride capsule, extended release [package insert].
Takeda Pharmaceuticals America, Inc. (2023). Intuniv- guanfacine tablet, extended release; Intuniv- guanfacine [package insert].
Wolraich, M. L., et al. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics.
