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Non-Stimulant Medications Available for ADHD Treatment

​​Some non-stimulant medicines may be appropriate for children who have been diagnosed with Attention Deficient Hyperactivity Disorder (ADHD) and certain coexisting conditions. These include ADHD with accompanying tic disorders (such as Tourette Syndrome), for example.. In some cases, these medicines can treat both conditions at the same time. Proven alternate choices of stimulant medications for children include Atomoxetine, Guanfacine XR, and Clonidine XR.

Non-Stimulant Medications for ADHD

Generic Class
(Brand Name)

Dosage

Prescribing Schedule


Atomoxetine (Strattera)


Once a day to twice a day

0.5 mg/kg per day increasing to 1.4 mg/kg per day

Guanfacine

  • Long acting (Intuniv)


1-4 mg daily


Start at lower doses

  • Short-acting (Tenex)


1-2 mg 2 to 3 times daily


Start at lower doses


Clonidine

  • Long-acting (Kapvay)


0.1 – 0.3 mg 2 to 3 times daily


Start at lower doses

  • Oral tablets


0.1 – 0.2 mg twice daily


Start at lower doses

  • Film patches


0.1 – 0.3 mg patch daily


Start at lower doses


Note:
These are newer FDA approved medications that have not been used as long as stimulants. Atomoxetine, guanfacine XR and clonidine XR are considered second-line (second-choice) treatments. Products are mentioned for informational purposes only and do not imply an endorsement by the American Academy of Pediatrics. Your doctor or pharmacist can provide you with important safety information for the products listed.

Atomoxetine

Atomoxetine (Strattera) is a non-stimulant approved by the FDA for the treatment of ADHD. It is in the class of medications known as selective norepinephrine reuptake inhibitors. Because atomoxetine does not have a potential for abuse, it is not classified as a controlled substance.

Atomoxetine is a newer medication and the evidence supporting its use is more limited than for stimulants. Atomoxetine, unlike stimulants, is active around the clock. However, atomoxetine has been found to be only about two-thirds as likely to be effective as stimulant medications. After starting atomoxetine, it may take up to 6 weeks before it reaches its maximum effectiveness.

Possible side effects

Atomoxetine has a warning on it that it may, in a very small number of cases, have some potential for causing suicidal thoughts in the first few weeks of treatment. Atomoxetine may be helpful in the treatment of children who have both ADHD and anxiety, since stimulants may worsen anxiety symptoms. Side effects are generally mild but can include decreased appetite, upset stomach, nausea or vomiting, tiredness, problems sleeping, and dizziness. Jaundice (turning yellow) is mentioned in a warning on the medication, but is extremely rare. Taking atomoxetine with food can help avoid nausea and stomachaches. Atomoxetine should be used in lower doses in children also taking certain antidepressants like fluoxetine (Prozac) or paroxetine (Paxil), because they can raise the atomoxetine levels in the bloodstream.

Atomoxetine is now considered an option for first-line therapy for ADHD, and is the first non-stimulant to fall into the first-line category. Parents concerned about the possibility that stimulants may be used for substance abuse may choose atomoxetine as the first-line agent for their child. It is often used for children who have had unsuccessful trials of stimulants.

Long-acting guanfacine

Long-acting guanfacine (Intuniv) is in the group of medications known as alpha agonists. These medications were developed for the treatment of high blood pressure but have also been used to treat children with ADHD who have tics, sleep problems, and/or aggression. It has recently been approved by the FDA for the treatment of children with ADHD.

Long-acting guanfacine is a pill, but it cannot be crushed, chewed, or broken and must be swallowed whole. Like atomoxetine, it is not a controlled substance.

Possible side effects

It does not suppress appetite much, so may be a good choice for children who lost a significant amount of weight when taking a stimulant. Side effects can include sleepiness, headaches, fatigue, stomachaches, nausea, lethargy, dizziness, irritability, decreased blood pressure, and decreased appetite. Although sleepiness occurs in a large number of children when children start taking long-acting guanfacine, it seems to get better as they continue to take it. It may take 3 to 4 weeks to see medication benefit.

Long-acting clonidine

Long-acting clonidine (Kapvay) is also FDA approved for the treatment of ADHD. It is taken twice a day while long acting guanfacine is once a day. Both long-acting alpha agonists have been studied for use alone or as an add-on to stimulants when the stimulant alone does not stop all the symptoms of ADHD.

Two other shorter-acting alpha agonists are available for use, but not approved by the FDA for ADHD. These are clonidine (Catapres) and short-acting guanfacine (Tenex). These can be used as adjunctive medications, or if FDA-approved medications are not helpful.

If no FDA-approved medication has been found helpful for your child, you should also consider whether ADHD is the correct diagnosis, and whether additional coexisting conditions might be present.

More information

Last Updated
9/23/2021
Source
American Academy of Pediatrics (Copyright © 2021)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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