The recent extension of the label to Qelbree, a non-stimulant drug for ADHD, has drawn attention to the limited options for non-stimulant treatment for adults with this condition.

Qelbree, a viloxazine pill, was first approved in April 2021 for the treatment of adolescents and children over six with ADHD. One week ago, the drug’s label was extended to patients over the age of 18, according to a press release of the company. This extension of the label is the latest development in the field of non-stimulant drugs for ADHD since the approval of Kapvay (clonidine hydrochloride) in 2010.

The treatment of ADHD consists mainly of stimulant drugs, which, although effective in most patients, can also cause side effects such as insomnia, agitation and loss of appetite, among others. In case of problems with tolerance or non-response to the class – which occurs in 30% of patients – patients have the option of non-stimulant drugs, which are reserved for later lines of therapy.

Although effective, stimulant drugs pose a risk of abuse even when drugs are prescribed and patients are monitored continuously, which is especially important for adolescents and adults. “There is a great need for non-stimulant opportunities for students due to the relatively high prevalence of stimulant abuse on university campuses,” said George DuPol, Ph.D., assistant dean of the research school psychology program at the University of Lehigh, Pennsylvania. Pharmaceutical technology.

ADHD affects approximately 16 million children, adolescents, and adults in the United States, of whom nearly 10 million are adults, underscoring the unmet need for a wide range of alternative treatment options to serve this population.

Stimulants are an effective first-line therapy for ADHD

ADHD stimulants, including the well-known drug brands Adderall, Ritalin and Concerta, consist of substances such as amphetamine or methylphenidate and are fast-acting. They act by blocking the dopamine and norepinephrine transporters, leading to the accumulation of neurotransmitter levels and subsequent stimulation in the cortical and subcortical areas of the brain. On the other hand, non-stimulants may include atomoxetine, which may increase dopamine and norepinephrine by inhibiting neurotransmitter transporters in the cortex alone. Other types of stimulants include tricyclic and non-tricyclic antidepressants and alpha-2 noradrenergic agonists, which may act not only on norepinephrine and dopamine, but also on serotonin levels.

According to Ronald Brown, PhD, a psychologist at the University of Nevada, Las Vegas, “the efficacy and safety of stimulants have been carefully studied and well documented over the past 50 years.” In addition to common side effects such as irritability, appetite suppression and insomnia, stimulants can also cause cardiovascular effects such as high blood pressure. But when used within the right dosage parameters, stimulants work well and their side effects can be easily managed, says Brown, an expert in the study of chronic diseases in children and adolescents.

Non-stimulants are not the first line of choice in ADHD, but if there are several contraindications or the patient is refractory, non-stimulants are a sufficient second choice of therapy, says Brown. Pharmaceutical technology. Therefore, there was no urgent need for vigorous research and development of new drugs, as stimulants work effectively in the majority of the ADHD population.

Anxious potential for abuse

However, when it comes to older people with ADHD, the potential for substance abuse abuse is of some concern. College students with ADHD “can often sell or give their stimulant drugs to their peers without ADHD” who use prescription drugs to study and improve their academic performance or for entertainment purposes, says DuPaul, whose work deals with emerging adults and students with ADHD. Therefore, “it is crucial to have alternatives to non-stimulant drugs that are effective in treating ADHD but do not have a high potential for abuse.”

ADHD is a neurological disorder characterized by cognitive and behavioral symptoms in early childhood. Although the disease manifests itself in the early years, the predominant symptoms of inattention, hyperactivity and impulsivity continue to appear in adulthood in up to 90% of children diagnosed with ADHD.

In addition, ADHD is a heterogeneous disorder and the choice of treatment strongly depends on the specific symptoms that each patient experiences. According to Brown, if patients have attention problems as their main symptom, then stimulants are the mainstay of treatment for children, adolescents and potentially even adults. If there is a history of abuse, contraindications, refractive response, or comorbidity of other disorders, such as depression with ADHD, then Qelbree would be a reasonable alternative.

However, more experiments are needed with Qelbree and other non-stimulants, examining functional impairments, cognitive performance and peer relationships to establish more data before advocating for non-stimulants as a reasonable alternative therapy, Brown said. Another important aspect to consider in ADHD, in addition to pharmacotherapy, is behavioral management. Medications combined with behavioral therapy, family counseling, psychosocial treatment, and skills training are the optimal treatment strategy, as they promote self-controlled behavior and self-mediation to meet the specific needs of both children and adult ADHD patients in various aspects of ADHD. their life.

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