Qelbree vs Adderall: What's the difference between them?

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Official answer

by Drugs.com

Overview

Qelbree (viloxazine ER) and Adderall (mixed amphetamine salts) are both oral medications used to treat attention deficit hyperactivity disorder (ADHD) in adults and children. Qelbree is used in adults and children 6 years of age and older, while Adderall is used in people 3 years and older.

  • The main differences are that Qelbree is a long-acting, once daily nonstimulant medicine and is not classified as a federally controlled substance. It is less likely to cause trouble with sleeping or lead to abuse. In studies, Qelbree has not been shown to lead to withdrawal symptoms or dependence.
  • Adderall is a short-acting stimulant medication given once or twice a day, and is a C-II controlled substance with the potential for misuse, drug dependence, and illicit distribution to others. The amphetamines in Adderall are dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate.

    • Common side effects that Qelbree and Adderall share include upset stomach (nausea, vomiting, stomach ache) and decreased appetite. Qelbree is more likely to cause drowsiness and headache, while Adderall may be more likely to cause trouble sleeping, weight loss or drug abuse or diversion.

    Other differences:

  • Dosing: Qelbree is given once per day as an oral capsule, and Adderall is usually given 1 to 3 times a day as an oral tablet. Adderall XR is available as a once-daily option.
  • Adderall is also approved by the FDA to treat the sleep disorder narcolepsy in adults and children 6 years and older. Other brand names for mixed salts of amphetamine and dextroamphetamine include Adderall XR (a long-acting form) and Mydayis. Qelbree is only approved for ADHD.
  • Adderall is available as a generic product in the US, which may help save you money. Qelbree is the more expensive product and does not have an approved generic option at this time.

    • See: Drugs.com Compare Tool - Qelbree vs. Adderall

    What is ADHD?

    Attention deficit hyperactivity disorder, or ADHD, is a common condition marked by ongoing issues related to attention, hyperactivity, and impulsiveness that can interfere with learning, development and daily functioning. It can occur in school aged children and adolescents and often persists into adulthood. In the U.S., just over 9% of children and up to 5% of adults are estimated to have ADHD.

    ADHD medicines should be used as part of a total treatment program for ADHD that may include counseling or other therapies. Behavioral treatments usually are recommended for preschool-aged children.

    Do Qelbree and Adderall work the same way?

    No. Qelbree is in the drug class known as selective norepinephrine reuptake inhibitors. These products prevent the reuptake of norepinephrine (a brain neurotransmitter) to improve focus and attention in patients with ADHD. It is not a stimulant and has not been shown to have a risk for abuse or drug dependence.

    Adderall is a central nervous system (CNS) stimulant that raises the neurotransmitter levels of dopamine and norepinephrine in the brain. This can help control hyperactivity, impulse control and increase attention. Adderall is a controlled substance and may have a risk for abuse or drug dependence.

    Table 1 describes the product availability, duration of action and cost comparison of Qelbree and Adderall.

    Table 1: Qelbree vs. Adderall for ADHD

    Product Availability Duration of Action / Uses Cost Comparison
    Qelbree (viloxazine ER)
  • 100, 150, 200 mg oral capsules.
  • Approved by the FDA in April 2021`
  • Generic option not yet available in the U.S. (as of April 2023)
    		•  Given once per day. Lasts throughout the day. Onset of full effect may take 1 to 2 weeks.

    Can be swallowed whole or sprinkled onto one teaspoonful of applesauce / pudding and swallowed immediately without chewing.

    Do not chew, cut or crush the capsules.May be taken with or without food.

    Safety / effectiveness of Qelbree not established in children younger than 6 years old.

    May be an alternative to using a stimulant if concerned with drug abuse or stimulant side effects.
  • $363 for 30 Qelbree capsules (one month supply).
  • Manufacturer discounts for Qelbree may be available from Supernus, the manufacturer.
  • Prices may vary based on location, coupons or discounts.
    		•
    Adderall (mixed salts of amphetamine and dextroamphetamine)
  • Generic oral tablets available: 5, 7.5, 10, 12.5, 15, 20, 30 mg oral tablets
  • Brand name immediate-release Adderall discontinued in the U.S.; extended-release Adderall XR, Mydayis brands, and generics are also available.
  • Adderall approved by the FDA Nov. 2002
    		•  Usually given 1 to 3 times per day. Lasts 4 to 6 hours. Onset of effect typically within 1 hour.

    Not recommended for use in children under 3 years of age.

    Started at the lowest recommended dose; doses are individually adjusted. Late evening doses should be avoided because of the resulting insomnia (trouble with sleep).

    May take with or without food.

    Keep Adderall (and generics) in a safe place to prevent misuse and abuse. Do not sell or give away Adderall as it may harm others, and it is against the law.
  • $14 to $25 for 100 tablets of generic Adderall (mixed amphetamine salts).
  • Prices may vary based on location, coupons or discounts.
    		•

    Common side effects: Qelbree and Adderall

    Most people tolerate these medicines well. But there are side effects and warnings you should be aware of and discuss with your healthcare provider if you have concerns.

    Common side effects that may occur with both Qelbree and Adderall include:

  • Stomach upset (nausea, vomiting, stomach pain)
  • Decreased appetite

    • Qelbree

    The most commonly reported side effects for Qelbree include:

  • somnolence / sedation (16%)
  • decreased appetite (7%)
  • fatigue (6%)
  • nausea (5%)
  • vomiting (4%)
  • insomnia / trouble sleeping (3%)
  • irritability (3%)

    • Side effects for Qelbree can differ slightly between adults and children. The most common side effects reported in adults (but not commonly in children) include: headache, dry mouth and constipation.

    About 3% (27 out of 826 patients) receiving Qelbree in studies stopped treatment due to a side effect, with somnolence (drowsiness, sedation, tiredness) being the main reason.

  • Side effects most commonly associated with stopping Qelbree treatment in children were somnolence, nausea, headache, irritability, tachycardia, fatigue, and decreased appetite.
  • In adults, side effects most commonly associated with discontinuation of Qelbree were fatigue, insomnia, constipation, and headache.

    • You should not operate a motor vehicle or hazardous machinery until you know how you will be affected by Qelbree. Patients treated with Qelbree should be monitored for suicidal thoughts and behavior and weight changes.

    Adderall

    Many side effects with stimulants are temporary and mild and can be addressed by your doctor by adjusting the dose or frequency.

    Some of the most common side effects of stimulants like Adderall include decreased appetite (up to 36%), trouble sleeping (up to 27%) and weight loss (up to 10%). You can improve appetite loss by taking the medicine within 30 minutes before a meal or right after eating.

    Less common side effects for Adderall include:

  • increased heart rate
  • increase in blood pressure
  • headache
  • social withdrawal
  • nervousness
  • irritability
  • stomach pain
  • poor circulation in the hands and feet
  • mood changes

    • Serious side effects are rare but can include dangerous heart side effects and psychiatric side effects like suicidal thinking, hallucinations, or aggressive behavior. Call your doctor or 911 right away if you notice unusual changes in behavior.

    Boxed Warnings

    Both agents contain a Boxed Warning, the FDA’s strongest warning for safety and side effects, some of which may be life-threatening, but the warnings differ. It is important to discuss these possible side effects with your healthcare provider.

  • Qelbree (viloxazine ER) contains a Boxed Warning for an increased risk of suicidal thoughts and actions in some children and adolescents with ADHD, especially within the first few months of treatment or when the dose is changed. Patients should be carefully monitored, and any new or sudden changes in mood or behavior should be reported right away to your healthcare provider.
  • Adderall (mixed salts of amphetamine and dextroamphetamine) contain a Boxed Warning for a high potential for drug misuse due to the fact this drug is a stimulant. Amphetamines given for prolonged periods may lead to drug dependence and must be avoided. People may try to obtain amphetamines for non-therapeutics uses or to distribute to others. This medicine should be prescribed or dispensed sparingly. Misuse of amphetamine may cause sudden death and serious cardiovascular (heart) side effects.

    • BOTH products also contain a warning for a dangerous drug interaction with MAOIs.

    DO NOT USE Qelbree or Strattera if you are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI. Combined use may lead to side effects that could be deadly.

  • MAOIs are an older class of drug used to treat severe depression and other mental health disorders.
  • MAO inhibitors include medicines like isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.
  • Ask your healthcare provider or pharmacist if you are not sure if you or your child takes an MAOI.

    • Be sure your doctor or pharmacist screens for drug interactions with any medicines you take, including prescription, over-the-counter (OTC), vitamins, and herbal or dietary supplements.

    Do not start or stop any new medicine during treatment without first talking to your healthcare provider. Your doctor can decide if it is safe for you to combine medicines.

    Do not use Qelbree if:

  • you take any of these drugs: alosetron, duloxetine, ramelteon, tasimelteon, tizanidine, or theophylline.

    • Do not use Adderall (or generic: mixed salts of amphetamine and dextroamphetamine) if you or your child:

  • are allergic or sensitive to Adderall or other stimulant medicines
  • have heart disease or hardening of the arteries
  • have moderate to severe high blood pressure
  • have hyperthyroidism
  • have glaucoma (an eye disease)
  • are very anxious, tense, or agitated
  • have a history of drug abuse

    • Serious side effects: Stimulants like Adderall can cause a stroke, heart attack, and sudden death in people with high blood pressure, heart disease, or a heart defect.

    Always review the Patient Medication Guide for any new information each time you get a prescription filled. Your pharmacist can give you a Medication Guide if you do not have one.

    This is NOT a complete list of possible common or serious side effects, precautions or warnings with Qelbree or Adderall. Call your doctor for medical advice about side effects.

    Related (in more detail):

  • Side effects, precautions and Warnings for Qelbree
  • Side effects, precautions and Warnings for Adderall

    • Which is more effective, Qelbree or Adderall?

    Head-to-head, randomized, comparative studies between Qelbree with Adderall are not available, so it is not possible to say which one is more effective. They both have been shown to be effective options for treating ADHD in studies when compared to a placebo (a pill with no active ingredient).

    Initially, stimulants like Adderall or Ritalin (or generic equivalents) are considered the gold standard for treating ADHD symptoms. They are often recommended for first-line treatment, when possible, in guidelines. However, effectiveness can vary among individuals and some people may have better results with the nonstimulants or tolerate the side effects better.

    In clinical studies, both Qelbree and Adderall have been shown to be effective in the treatment of ADHD in adults and children. Selection of one product over the other may depend upon your preference or that of your healthcare provider, concern over side effects, a history of drug abuse or misuse, and cost.

    Approval for Qelbree was supported by data from Phase III randomized, placebo-controlled studies of over 1,000 children 6 to 17 years of age. Doses studied were 100 mg, 200 mg, or 400 mg per day, with treatment duration of 6 to 8 weeks. The primary efficacy measure, the change in the ADHD-RS-5 Total Score from baseline, was met statistically for all doses.

    Nonstimulants like Qelbree or Strattera may be selected agents for treatment of ADHD for patients when substance abuse is a concern, either for the patient or family. Nonstimulants may also be preferred for children with tics, Tourettes or who have had previous severe side effects with stimulants.

    Your doctor may decide to combine a nonstimulant with prescription stimulants, or use a nonstimulant when stimulants cannot be used, have been ineffective, or are not well-tolerated.

    It is important to remember that research shows that ADHD stimulant treatment decreases the risk of substance abuse and may delay the onset through adolescence (although risks may still be present in the house with family members or friends). Adolescents with ADHD have also been shown to have fewer car accidents when being treated for ADHD compared to those who are not treated.

    In addition, for children under the age of 6, Parent Training in Behavior Management (PTBM) and / or behavioral classroom interventions are the first line of treatment. The use of medications, with or without PTMB, are the first-line therapy for school-aged children (≥6 years) and adolescents who meet diagnostic criteria for ADHD.

    Bottom Line

  • Qelbree and Adderall are both oral medications that are effective in treating ADHD in children and adults. Qelbree, a nonstimulant, is classified as a selective norepinephrine reuptake inhibitor and Adderall is a CNS stimulant (a mixed amphetamine salt).
  • Qelbree is an extended-release capsule given once per day, while Adderall is an oral tablet given 1 to 3 times per day depending upon patient needs. Both products can be taken with or without food.
  • Adderall is available as a generic option, but Qelbree is only available as a brand name product at this time, which makes it more expensive. Insurance is more likely to pay for Adderall due to the generic availability.
  • Adderall is a controlled substance and is associated with misuse, abuse and drug dependence, but Qelbree is not a controlled substance.

    • This is not all the information you need to know about Qelbree and Adderall for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

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