TaperCommunityviloxazine
Boxed Warning
Increased risk of suicidal thoughts and behavior in pediatric and young adult patients. Monitor closely during initial therapy and dose changes.
Viloxazine ER (Qelbree) is a non-stimulant medication approved in 2021 for the treatment of attention-deficit/hyperactivity disorder (ADHD) in patients aged 6 and older. Originally developed as an antidepressant in Europe in the 1970s, it was reformulated and re-approved as an extended-release ADHD treatment.
100mg, 150mg, 200mg ER
Extended-release capsules: 100mg, 150mg, 200mg
Insufficient data — discuss with prescriber
Selective norepinephrine reuptake inhibitor with serotonergic activity (5-HT2C receptor agonist, 5-HT2B receptor antagonist). The combined noradrenergic and serotonergic modulation is thought to underlie its efficacy in ADHD.
Viloxazine ER is dosed once daily and is generally well tolerated on discontinuation, but rebound ADHD symptoms and mild dysphoria can occur. Use available capsule strengths to step down.
There is limited published deprescribing data for viloxazine given its recent approval. A stepwise reduction by available capsule strengths over 2-4 weeks is reasonable for most patients. Slower for those with prior antidepressant withdrawal sensitivity.
Evidence-based phased reduction schedule. Always taper under medical supervision.
| Phase | Duration | Notes |
|---|---|---|
| Initial reductions | 1-2 weeks | Step down by 100mg increments using available capsule strengths. |
| Final reductions | 1-2 weeks | Hold at 100mg for several days, then discontinue. Slower for sensitive patients. |
1-3 days after dose reduction
3-7 days
Typically within 1-2 weeks
Rebound ADHD symptoms and irritability may persist 2-3 weeks; uncommon beyond that
Practical insights shared by members tapering Qelbree. Not medical advice — always consult your prescriber.
Toxicity
Suicidal ideation in pediatric and young adult patients. Increased blood pressure and heart rate. Mild somnolence and decreased appetite are common.
Pharmacokinetics
Tmax ~5 hours after oral ER administration. Bioavailability ~88%. High-fat meal reduces Cmax by ~9% and AUC by ~8%; can be taken with or without food.
~80 L
Extensively metabolized via CYP2D6 (minor) and UGT1A9/UGT2B15 to inactive 5-hydroxy-viloxazine glucuronide.
Renal (~90% as metabolites), <1% unchanged.
~76–82%
~13 L/h
Browse our map of deprescribing-informed providers worldwide.