ADHD Wiki
English

Non-stimulant medication

Full page: about 4 min Draft — not yet reviewed by a human

Summary

  • Atomoxetine has more adult trials than other non-stimulants; each drug's evidence and uses need separate assessment.
  • Average improvement with atomoxetine can grow over time. The first few days cannot establish its final effect.
  • Non-stimulants can affect pulse and blood pressure too. Different drugs may raise or lower them.

Ways to apply

  1. On your own

    Free, no special equipment to buy

    1. Describe prior medication problems: no benefit, unsuitable duration or intolerable side effects.
    2. Ask about adult evidence, locally approved uses and whether the drug suits your health.
    3. Agree on follow-ups and log symptom changes. Contact the clinician promptly for intolerable effects.

Atomoxetine has more adult trials than other non-stimulants

Research-backed

In an analysis of adult attention-deficit/hyperactivity disorder (ADHD) trials, atomoxetine had the most studies. Guanfacine and extended-release viloxazine also had evidence of symptom reduction, but far fewer adult trials(Radonjić et al., 2023).

The UK’s National Institute for Health and Care Excellence (NICE) recommends atomoxetine for adults unable to tolerate methylphenidate or lisdexamfetamine, or with insufficient benefit after separate adequate trials of both. Guanfacine for adults is an off-label use and needs advice from a tertiary ADHD service(NICE, 2018).

Average improvement with atomoxetine can grow over time

Research-backed

A pooled analysis of two adult trials found a difference between atomoxetine and placebo groups by week one. Average improvement in the atomoxetine group generally increased over time(Wietecha et al., 2016).

A lack of noticeable change in the first few days is not enough to judge treatment ineffective. Assessment can follow the schedule agreed with the clinician. Intolerable effects warrant prompt contact with the clinician, without waiting for benefits to appear(NICE, 2018).

Pulse and blood pressure can rise or fall

Research-backed

An analysis of mainly short-term trials in children, adolescents and adults found that atomoxetine and viloxazine may raise pulse or blood pressure, while guanfacine may lower them(Farhat et al., 2025).

The label “non-stimulant” cannot replace a safety assessment of the specific drug. For example, sustained low blood pressure on standing or fainting during guanfacine treatment requires a clinician to reassess treatment(NICE, 2018).

Evidence

References (4)
  1. Meta-analysisNonstimulant Medications for Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults: Systematic Review and Meta-analysisRadonjić, Bellato, Khoury, Cortese, Faraone (2023). CNS Drugs
  2. GuidelineAttention deficit hyperactivity disorder: diagnosis and managementNICE (2018). NICE guideline NG87
  3. Randomized trialAtomoxetine Increased Effect over Time in Adults with Attention‐Deficit/Hyperactivity Disorder Treated for up to 6 Months: Pooled Analysis of Two Double‐Blind, Placebo‐Controlled, Randomized TrialsWietecha, Clemow, Buchanan, Young, Sarkis, Findling (2016). CNS Neuroscience & Therapeutics
  4. Meta-analysisComparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysisFarhat, Lannes, Del Giovane, Parlatini, Garcia-Argibay, Ostinelli, Tomlinson, Chang, Larsson, Fava, Montastruc, Cipriani, Revet, Cortese (2025). The Lancet Psychiatry