9 Qelbree Interactions to Know About: Caffeine Melatonin, and More

Many people living with attention-deficit hyperactivity disorder (ADHD) take medication to help manage their symptoms. Qelbree (viloxazine) is an example of a nonstimulant ADHD medication. It’s a once-daily oral capsule that’s FDA approved for people ages 6 and older.

If you’re just starting Qelbree, you likely have questions. The recommended dosage and side effects are often the first things to come to mind. But interactions, while sometimes overlooked, are important to know about, too. For instance, did you know that Qelbree and coffee don’t mix well? Or how about the fact that this ADHD treatment also interacts with some antidepressants?

Here’s what you should know about some notable Qelbree interactions.

Qelbree interactions at a glance

Qelbree interacts with many prescription and over-the-counter (OTC) medications, as well as certain supplements and dietary items. Some interacting substances can cause serious side effects when combined with Qelbree. So it’s good to know about them.

Medications, supplements, and substances to avoid while taking Qelbree include:

• Monoamine oxidase inhibitors (MAOIs), such as selegiline (Zelapar, Emsam)

• Duloxetine (Cymbalta), a serotonin and norepinephrine reuptake inhibitor (SNRI)

• Melatonin, an OTC supplement for sleep

• Caffeine, including caffeine in supplements, foods, and beverages

• Tizanidine (Zanaflex)

• Ramelteon (Rozerem)

• Tasimelteon (Hetlioz)

• Alosetron (Lotronex)

Medications that may require dosage changes to be combined with Qelbree:

• Clozapine (Clozaril)

• Atomoxetine (Strattera)

• Dextromethorphan (Delsym) and medications that contain it

• Venlafaxine (Effexor XR), an SNRI

• Some tricyclic antidepressants (TCAs), such as desipramine (Norpramin)

• Tolterodine (Detrol)

• Certain beta blockers, such as metoprolol (Lopressor, Toprol XL)

• Tramadol (ConZip, Qdolo)

• Benzodiazepines, such as alprazolam (Xanax)

• Certain statins, such as simvastatin (Zocor)

• Certain blood thinners, such as apixaban (Eliquis)

This isn’t a complete list of medications and substances that can cause Qelbree interactions. Share an updated medication list with your prescriber and pharmacist before starting Qelbree. They can let you know if you can take it safely with your other medications.

Below are details about nine notable Qelbree interactions.

1. MAOIs

Qelbree interacts with MAOIs, such as selegiline. These medications treat depression and Parkinson’s disease. Certain antibiotics, such as linezolid (Zyvox), also fall into this group. In addition to requiring certain dietary restrictions, MAOIs interact with an extensive list of medications. Qelbree is included in this list.

Taking Qelbree within 2 weeks of an MAOI can cause a hypertensive crisis (life-threateningly high blood pressure). So you shouldn’t take Qelbree and MAOIs together or close together. This combination is contraindicated, meaning it should be avoided because the risks greatly outweigh the benefits.

If you’re taking an MAOI, you’ll need to stop it for at least 2 weeks before you start taking Qelbree. Or if you’re already taking Qelbree, you’ll need to stop it at least 2 days before you start taking an MAOI.

2. Certain SNRIs, such as duloxetine

Qelbree also interacts with the SNRIs duloxetine and venlafaxine. SNRIs are prescribed for depression and certain types of chronic pain. Qelbree can cause duloxetine and venlafaxine to stay in your system longer than expected. This can increase the risk of side effects, such as nausea, headaches, and raised blood pressure.

The interaction between Qelbree and duloxetine is more significant. This combination is contraindicated and should be avoided. Though, it’s not recommended for most people to take Qelbree with venlafaxine, either. There are some cases when the combination may be necessary, but this usually means taking a lower dosage of venlafaxine than what’s typically prescribed.

3. Melatonin

You shouldn’t take melatonin with Qelbree. Melatonin is an OTC supplement that’s marketed for sleep. Qelbree can slow down the process of your body clearing melatonin. This can lead to excessive or lingering side effects, such as drowsiness and dizziness.

It’s contraindicated to take Qelbree and melatonin together. If you’ve been taking melatonin for sleep troubles, speak with your healthcare team about alternatives before starting Qelbree. There are sleep medications and supplements that are safer to combine with Qelbree.

4. Caffeine

Many people may not realize that their morning cup of coffee doesn’t mix well with certain medications. Qelbree is one of those medications. It can cause caffeine to hang around in your body for longer. This can lead to more caffeine-related side effects, such as anxiety or high blood pressure.

Qelbree’s manufacturer doesn’t recommend combining the medication with any amount of caffeine. The combination is contraindicated. But this doesn’t just mean avoiding coffee. Keep an eye out for caffeine in other sources, such as:

• Tea

• Sodas

• Energy drinks

• Caffeinated gum and candy

• Coffee-flavored foods, such as ice cream and yogurt

• OTC or prescription migraine treatments, such as Excedrin (acetaminophen / aspirin / caffeine)

• OTC menstrual cramp relief products, such as Midol Complete (acetaminophen / caffeine / pyrilamine)

• OTC diuretics (water pills)

• OTC energy supplements

It’s best to reduce (or ideally eliminate) your caffeine intake before starting Qelbree. But this can be difficult for some people, so speak with your prescriber if you need help.

5. Tizanidine

Qelbree also interacts with the muscle relaxer tizanidine. Like with other interactions, Qelbree can cause tizanidine to hang around longer in your system. And this can cause excessive side effects, including severe drowsiness and low blood pressure.

It’s contraindicated to take Qelbree with tizanidine. So you should avoid this combination. Your prescriber can recommend a muscle relaxer that’s safer to combine with Qelbree.

6. Clozapine

Clozapine is a medication that’s approved for hard-to-treat schizophrenia. It has many interactions, including with Qelbree. Qelbree can cause clozapine to remain in your body longer than usual. And this can raise the risk of clozapine side effects, such as low blood pressure and drowsiness.

Most people should avoid taking both Qelbree and clozapine if possible. But if this combination is needed, your prescriber may need to lower your clozapine dosage. This can help limit the side effects caused by this interaction.

7. Atomoxetine (Strattera)

Atomoxetine, the active ingredient in Strattera, is a nonstimulant ADHD medication that works similarly to Qelbree. So it makes sense that you shouldn’t take both. Taking Qelbree with atomoxetine can cause excessive side effects. These include nausea, fatigue, and a smaller appetite.

It’s unlikely that your healthcare professional would prescribe you both Qelbree and atomoxetine. If you’re taking one of these medications and feel like it isn’t working well enough for your ADHD symptoms on its own, tell your prescriber. They may suggest a dosage or medication change.

8. Dextromethorphan

Qelbree also interacts with dextromethorphan, an OTC cough medication. Qelbree can cause dextromethorphan to stay in your body longer than expected. This raises your risk of dextromethorphan side effects, such as dizziness and nausea.

Dextromethorphan is included in many OTC and prescription medications. So be sure to read product labels carefully. It’s common for OTC cold medications to include the abbreviation “DM” on products that contain dextromethorphan.

Examples of medications that contain dextromethorphan and interact with Qelbree include:

• Most Delsym products

• Many Mucinex products, such as Mucinex DM (guaifenesin / dextromethorphan)

• Many Robitussin products, such as Robitussin DM (guaifenesin / dextromethorphan)

• Prescription cough medications, such as promethazine DM

• Auvelity (dextromethorphan / bupropion), an antidepressant

You may still be able to take dextromethorphan with Qelbree if a healthcare professional recommends it. But if you’re noticing excessive dextromethorphan side effects, let them know. You may need to take a lower or less frequent dosage.

9. Some TCAs, such as desipramine

Qelbree interacts with certain TCAs, such as desipramine and nortriptyline. Like with interactions discussed above, Qelbree can cause these TCAs to stay in your system longer. This could raise your risk of TCA side effects, including dry mouth and constipation.

You may not need to completely avoid combining Qelbree and TCAs. But if you start to experience more side effects after combining medications, tell your prescriber. They may want to lower your TCA dosage.

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Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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