Qelbree Tapering Guide
viloxazine
Boxed Warning
Increased risk of suicidal thoughts and behavior in pediatric and young adult patients. Monitor closely during initial therapy and dose changes.
Overview
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
Mechanism of Action
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.
Taper Notes
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.
Hyperbolic Tapering Guidance
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.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Tapering Protocol
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. |
Withdrawal Timeline
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
Community Tips
Practical insights shared by members tapering Qelbree. Not medical advice — always consult your prescriber.
- 1Viloxazine is too new for a large body of community experience — share what you observe so others can learn.
- 2Capsules can be opened onto applesauce if swallowing whole capsules is difficult — do not chew or crush.
- 3If you take other CYP1A2 substrates (e.g., caffeine in large amounts, theophylline), expect their levels to rise while on viloxazine and fall after stopping.
- 4Many members find rebound ADHD symptoms more bothersome than withdrawal; coordinate with your prescriber on what comes next.
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- MAOIs — contraindicated within 14 days
- Sensitive CYP1A2 substrates (theophylline, tizanidine, duloxetine) — viloxazine is a strong CYP1A2 inhibitor; avoid or reduce dose
- CYP2D6 substrates may have modest exposure increases
Food Interactions
- May be taken with or without food
- Capsules may be opened and sprinkled on applesauce; do not chew
Contraindications
- Concurrent or recent (within 14 days) MAOI use
- Concomitant use with sensitive CYP1A2 substrates with narrow therapeutic index
- Known hypersensitivity to viloxazine
Toxicity
Suicidal ideation in pediatric and young adult patients. Increased blood pressure and heart rate. Mild somnolence and decreased appetite are common.
Pharmacokinetics
ADME Profile
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
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Other Drug Profiles
Sources & References
Qelbree (viloxazine) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Regulatory sources
Official prescribing information and safety notices.
Peer-reviewed research
Primary literature cited in this taper guide.
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
- Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)
- Framer A 2021 — The patient voice: an exploration of the experience of withdrawal from antidepressants (Therapeutic Advances in Psychopharmacology)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.