ViloxazineViloxazine Hydrochloride

About Viloxazine

Viloxazine belongs to a class called selective norepinephrine reuptake inhibitors, though exactly how it works in ADHD is not known. It is approved for ADHD in adults and in children six and older and is taken once a day, with or without food. Children aged 6 to 11 start at 100 mg and can go up by 100 mg a week to 400 mg; ages 12 to 17 start at 200 mg and can go up to 400 mg after a week; adults start at 200 mg and can rise by 200 mg a week to 600 mg. In severe kidney impairment the start is 100 mg and the most is 200 mg a day.

The boxed warning says higher rates of suicidal thoughts and behavior were reported with Qelbree than with placebo in ADHD studies, so everyone taking it is watched closely for worsening and for suicidal thoughts; before starting, the prescriber screens for a personal or family history of suicide, bipolar disorder and depression. It can raise heart rate and diastolic blood pressure, which are checked before starting, after dose increases and periodically; it can trigger mania or hypomania in bipolar disorder; and it can cause sleepiness and fatigue, so do not drive until you know how it affects you. It must not be taken with an MAO inhibitor or within 14 days of stopping one, or with alosetron, duloxetine, ramelteon, tasimelteon, tizanidine or theophylline, because it strongly blocks CYP1A2, the enzyme that clears them. Sleepiness, fatigue, decreased appetite, nausea and insomnia are common, with vomiting and irritability also common in children and headache, dry mouth and constipation in adults.

FDA reviewers recommended that viloxazine not be controlled, and it is not a controlled substance, so unlike stimulants its prescriptions can carry refills. The capsule can be swallowed whole, or opened and the whole contents sprinkled on a teaspoon or tablespoon of applesauce, eaten within 2 hours, or pudding, eaten within 15 minutes. The label says it may harm the mother during pregnancy, so it is stopped when pregnancy is recognized unless the benefit outweighs the risk; it passes into breast milk in low amounts, with effects on the infant unknown. Decreased appetite is common, and the label advises monitoring weight during treatment.

Taking Viloxazine

How to take it

Once a day, with or without food, at about the same time each day. Swallow the capsule whole without chewing or crushing it, or open it and sprinkle the entire contents on a teaspoon or tablespoon of applesauce (taken within 2 hours) or pudding (within 15 minutes); do not save the mixture for later.

If you miss a dose

Take it as soon as you remember, unless the next dose is nearly due; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the original container, tightly closed, away from heat and moisture and not in the bathroom, out of reach of children. Use a take-back program for capsules you no longer need rather than flushing them.

Interactions to know about

Never with an MAO inhibitor or within 14 days of one, and not with alosetron, duloxetine, ramelteon, tasimelteon, tizanidine or theophylline; other medicines cleared by CYP1A2 are not recommended or need a lower dose. It weakly slows the breakdown of medicines cleared by CYP2D6 and CYP3A4, so their doses may need adjusting. Tell the prescriber about any personal or family history of suicide, bipolar disorder, depression or mania, and about blood pressure or heart rate problems, severe kidney problems, pregnancy or breastfeeding.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Viloxazine differs from pharmacy to pharmacy

Viloxazine is sold by one company and has no generic, so it is priced as a brand everywhere, and quotes differ by each pharmacy’s markup and fee; a pharmacy that does not stock it may need to order it. Higher doses take two or three capsules a day, so the dose and the mix of strengths drive the price, and a dose such as 300 mg can be made from different capsule combinations. Because it is not controlled, a prescription can usually be transferred to a pharmacy that quotes less.

Ways to pay less for Viloxazine without insurance

• Ask the maker whether its savings or patient assistance program applies to someone paying cash; many copay cards require commercial insurance.
• Ask the pharmacy to quote the capsule combinations that make up your dose, for example two 150 mg capsules against one 200 mg and one 100 mg.
• Ask for a ninety-day supply once your dose is stable, and compare more than one pharmacy.
• If cost is a barrier, ask the prescriber whether a generic non-stimulant such as atomoxetine or extended-release guanfacine would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Viloxazine

1. 1.Can my child’s capsule be opened onto applesauce or pudding, and how long can the mixture sit?
2. 2.Is it safe with my other medicines, such as duloxetine, tizanidine or theophylline?
3. 3.When should my heart rate and blood pressure be checked?
4. 4.Which mood changes or thoughts should I report right away?

Related medications