Strattera vs Qelbree: the two non-stimulants approved for adults

Strattera (atomoxetine) and Qelbree (viloxazine) are the two non-stimulant medicines with FDA labeling for ADHD in adults. Both act mainly on norepinephrine, neither is a controlled substance, and both carry a boxed warning about suicidal thoughts and behaviors. They differ in which liver enzymes matter, which other medicines they clash with, how they can be taken, and whether a generic exists. This page compares them using the current FDA labels, as of October 2026.

A note on names: as of the Orange Book edition dated October 9, 2026, Eli Lilly's brand Strattera capsules are listed as discontinued, with an FDA determination that they were not withdrawn for safety or effectiveness reasons. Generic atomoxetine capsules from several manufacturers remain approved. This page uses "Strattera" because that is the name people search for.

Side by side

Interactions: the biggest practical difference

The two drugs run into trouble with other medicines in opposite ways.

• Atomoxetine is affected by others. It is broken down mainly by the liver enzyme CYP2D6. The Strattera label reports that taking it with paroxetine or fluoxetine, both strong CYP2D6 inhibitors, raised atomoxetine exposure six- to eightfold in people who were not poor metabolizers. People who are genetically CYP2D6 poor metabolizers also have higher levels, and the label says genetic testing for CYP2D6 status can be considered. The label adjusts how the dose is increased in both situations.
• Viloxazine affects others. Viloxazine inhibits CYP1A2, so it can raise the levels of drugs that depend on that enzyme. The label makes this a contraindication for sensitive CYP1A2 substrates or those with a narrow therapeutic range. The Qelbree Medication Guide names alosetron, duloxetine, ramelteon, tasimelteon, tizanidine and theophylline among the medicines to tell the prescriber about.

Both are contraindicated with MAOIs. Anyone taking an antidepressant, a sleep medicine or a muscle relaxant should bring a complete medication list. The drug interactions page has more.

Safety warnings compared

Suicidal thoughts. Both labels carry a boxed warning. The current Strattera label frames it around pediatric patients 6 and older, based on short-term pediatric studies. The Qelbree label states that higher rates of suicidal thoughts and behaviors were reported in both pediatric and adult patients treated with Qelbree than with placebo, and asks prescribers to monitor all patients, especially early on and when the dose changes.

Liver. The Strattera label says to stop it and not restart it in anyone with jaundice or lab evidence of liver injury. Qelbree's label does not carry that warning.

Heart, blood pressure and mood. Both raise heart rate and blood pressure in some people, and both labels call for checking them before treatment, after dose increases and periodically. Both warn about triggering mania in people with bipolar disorder, so screening for a personal or family history of bipolar disorder comes first. Strattera adds contraindications for pheochromocytoma, narrow angle glaucoma and severe cardiovascular disease.

Sleepiness. In the Qelbree adult trial, sleepiness was reported in 6% of people on Qelbree vs 2% on placebo, and fatigue in 12% vs 3%. The Strattera label also advises caution with driving until people know how it affects them.

What the research says

A head-to-head trial of atomoxetine against viloxazine in adults was not found for this guide. Atomoxetine has the larger evidence base. In the 2018 Lancet Psychiatry network meta-analysis, atomoxetine reduced clinician-rated adult symptoms more than placebo but was less well tolerated than placebo; that analysis predates viloxazine's approval and did not include it. A 2025 adult analysis (Ostinelli and colleagues) again found atomoxetine effective on both self-reported and clinician-reported symptoms, with lower acceptability than placebo, meaning more people stopped. Qelbree's adult approval rests on a placebo-controlled trial in adults aged 18 to 60 described in its label.

Reviews such as American Family Physician (2024) describe atomoxetine and viloxazine as options for adults who are unable to take stimulants or who have concurrent anxiety or depression. See stimulants vs Strattera for that broader comparison, and the drug pages for Strattera and Qelbree for full label summaries.

Cost and access

Generic atomoxetine is made by several companies. Qelbree has no generic as of October 2026, so plan coverage and prior authorization rules matter more. What ADHD medication costs in New York explains how to check a formulary.

Because neither atomoxetine nor viloxazine is a controlled substance, the Schedule II rules that govern stimulants in New York and New Jersey (such as the ban on refills, the short window to fill, and the supply limits) do not apply to them. New Jersey's 2026 in-person visit requirements for telehealth patients are written for Schedule II stimulants. For the stimulant rules these medicines avoid, see New York's rules for ADHD stimulant prescriptions and New Jersey's rules.

Questions worth asking

• Do any of my current medicines involve CYP2D6 or CYP1A2?
• Do I have liver disease, glaucoma, heart disease or a history of bipolar disorder?
• Would sleepiness affect my driving or work?
• Is the cost difference between a generic and a brand-only medicine significant on my plan?
• How long should I give it before deciding whether it helps?

Talking it through with a prescriber

Dr. Shershow is a psychiatrist focused on adult ADHD, licensed in New York and New Jersey. After an evaluation, he discusses the treatment options that fit, which can include non-stimulant medication. This page is general information. It is not advice to start, stop or switch a medication, and neither drug is the right choice for everyone.