Non-Stimulant ADHD Medications: Complete Guide

By Dr. Ryan Sultan, MD
Double Board-Certified Psychiatrist (Adult & Child/Adolescent)
Columbia University Irving Medical Center | Integrative Psych NYC

Home → ADHD Resources → Non-Stimulant ADHD Medications

Home | ADHD Guide | ADHD Medications | ADHD Treatment NYC | Contact

Table of Contents

• Why Choose Non-Stimulant ADHD Medications?
• How Effective Are Non-Stimulants vs. Stimulants?
• Strattera (Atomoxetine): The Most Studied Non-Stimulant
• Wellbutrin (Bupropion): The Dual-Purpose Option
• Intuniv (Guanfacine): For Hyperactivity & Emotional Regulation
• Qelbree (Viloxazine): The Newest FDA-Approved Option
• Clonidine & Kapvay: Blood Pressure Medications for ADHD
• Side-by-Side Comparison of All Non-Stimulants
• Combining Non-Stimulants with Stimulants
• How to Choose the Right Non-Stimulant
• Switching from Stimulants to Non-Stimulants
• Frequently Asked Questions

Why Choose Non-Stimulant ADHD Medications?

Stimulants (Adderall, Vyvanse, Ritalin, Concerta) are the gold standard for ADHD treatment—but there are many good reasons to consider non-stimulants. (Note: Learn about evidence-based medication classification beyond the "stimulant" vs "non-stimulant" labels.)

Medical Contraindications to Stimulants

• Heart conditions: Stimulants increase heart rate and blood pressure. If you have arrhythmias, structural heart disease, or uncontrolled hypertension, non-stimulants are safer.
• Tic disorders: Stimulants can worsen tics in Tourette syndrome. Intuniv and Clonidine actually help with tics.
• Anxiety disorders: Stimulants can increase anxiety in some people. Non-stimulants like Strattera or Wellbutrin may be better tolerated.
• Glaucoma: Stimulants can increase intraocular pressure.
• Hyperthyroidism: Stimulants can worsen symptoms.

Intolerable Side Effects from Stimulants

• Appetite suppression: If you're already underweight or have a history of eating disorders, non-stimulants cause less appetite loss.
• Insomnia: Stimulants can make sleep problems worse. Non-stimulants like Intuniv actually help with sleep.
• Irritability/mood changes: Some people become irritable or emotionally flat on stimulants.
• Rebound effect: When stimulants wear off, some people experience a crash. Non-stimulants provide smoother 24-hour coverage.
• Jitteriness/physical restlessness: Stimulants can feel too "activating" for some people.

Substance Use History

• Stimulants are Schedule II controlled substances with abuse potential
• If you have a personal or family history of substance use disorder, non-stimulants are safer
• No risk of diversion, misuse, or dependence with non-stimulants
• Easier for recovery programs (some don't allow controlled substances)

Practical Considerations

• Controlled substance regulations: Stimulants require monthly refills, can't be called in by phone, difficult to get early refills when traveling
• 24-hour coverage: Non-stimulants work around the clock, no need to time doses
• Less stigma: Some people are uncomfortable taking "amphetamines" due to misconceptions
• Comorbid conditions: Non-stimulants can treat both ADHD and another condition (e.g., Wellbutrin for ADHD + depression)

Personal Response

• Some people simply respond better to non-stimulants
• Trial-and-error is often needed to find the right medication
• Don't assume stimulants are automatically better—individual biology varies

How Effective Are Non-Stimulants vs. Stimulants?

The honest answer: Stimulants are more effective for most people, but non-stimulants work well for many.

Response Rates

What this means:

• If you try a stimulant, you have a 70-80% chance of significant improvement
• If you try a non-stimulant, you have a 40-50% chance of significant improvement
• BUT: Individual response varies. Some people who don't respond to stimulants DO respond to non-stimulants

What "Response" Means

A "response" typically means at least a 25-30% reduction in ADHD symptoms plus functional improvement (better at work/school, relationships, daily tasks).

This doesn't mean symptoms disappear—it means meaningful improvement in quality of life.

Time to Effect

Major difference: Non-stimulants require patience. You won't know if they're working for several weeks, unlike stimulants which work immediately.

Strattera (Atomoxetine): The Most Studied Non-Stimulant

Strattera was the first non-stimulant medication FDA-approved specifically for ADHD (2002). It's the most researched and most commonly prescribed non-stimulant.

How Strattera Works

Strattera is a selective norepinephrine reuptake inhibitor (NRI). It increases norepinephrine in the prefrontal cortex, improving attention and executive function.

Unlike stimulants (which affect both dopamine and norepinephrine immediately), Strattera works gradually over weeks.

Effectiveness

• Response rate: 40-50% (vs 70-80% for stimulants)
• Symptom reduction: 25-35% on average
• Best for: Inattentive symptoms, comorbid anxiety
• Less effective for: Hyperactivity (compared to stimulants)

Dosing

Starting dose: 40 mg once daily (or 25 mg for children)

Target dose: 80-100 mg daily (1.2-1.4 mg/kg body weight)

Maximum dose: 100 mg daily

Timing: Can be taken once daily (morning or evening) or split into two doses. Taking at bedtime may reduce nausea.

Side Effects

Common (>10%):

• Nausea (20-30%, usually first 2 weeks, taking with food helps)
• Decreased appetite (15-20%, less than stimulants)
• Fatigue/drowsiness (10-15%, especially when starting)
• Dry mouth (10%)

Less common but notable:

• Sexual side effects (5-10%: decreased libido, erectile dysfunction, difficulty with orgasm)
• Urinary hesitancy/retention (5%, more common in adult men)
• Increased heart rate and blood pressure (modest, less than stimulants)
• Mood changes (irritability or emotional flatness in some people)

Rare but serious:

• Liver injury (very rare, <1 in 50,000, but monitor if jaundice develops)
• Suicidal thoughts (black box warning, mostly in youth, monitor closely first few weeks)
• Severe allergic reactions (rare)

Advantages of Strattera

• ✅ 24-hour coverage – no wearing off, consistent all day and night
• ✅ Not a controlled substance – easier refills, can call in prescriptions
• ✅ No abuse potential – safe for people with substance use history
• ✅ Helps with anxiety – can reduce comorbid anxiety symptoms
• ✅ Doesn't worsen tics – safe for Tourette syndrome
• ✅ Doesn't affect appetite as much – better for underweight individuals

Disadvantages of Strattera

• ❌ Takes 4-6 weeks to work fully (vs immediate with stimulants)
• ❌ Less effective overall than stimulants (50% response vs 75%)
• ❌ Nausea is very common initially
• ❌ Sexual side effects can be problematic
• ❌ Expensive if no generic available ($300-400/month brand; generic $50-150)
• ❌ Can't "skip days" – must take consistently to maintain effect

Who Strattera Works Best For

• Adults who can't take stimulants (heart issues, anxiety, substance use history)
• People who prefer 24-hour coverage without wearing off
• Comorbid ADHD + anxiety (stimulants might worsen anxiety)
• Jobs requiring random drug testing or where controlled substances are restricted
• People who had partial response to stimulants and want to add something for evening/nighttime

Wellbutrin (Bupropion): The Dual-Purpose Option

Wellbutrin is technically an antidepressant, but it's commonly used off-label for ADHD. It's FDA-approved for depression and smoking cessation, but not ADHD—yet it's widely prescribed for ADHD.

Read our detailed guide: Wellbutrin for ADHD: Complete Evidence Review →

How Wellbutrin Works

Wellbutrin is a norepinephrine-dopamine reuptake inhibitor (NDRI). It increases both dopamine and norepinephrine—similar mechanism to stimulants, but much weaker and slower.

Effectiveness for ADHD

• Response rate: 40-50%
• Effect size: Smaller than stimulants or Strattera
• Best for: ADHD + depression, motivation/energy, adult ADHD with mild symptoms
• Less effective for: Severe inattention or hyperactivity

Dosing

Starting dose: 150 mg XL once daily

Target dose: 300 mg XL once daily

Maximum dose: 450 mg XL daily (rarely needed for ADHD)

Formulations:

• Wellbutrin SR: Twice daily (not recommended—more seizure risk)
• Wellbutrin XL: Once daily (preferred for ADHD)

Side Effects

Common:

• Insomnia (10-20%, take in morning)
• Dry mouth (10%)
• Headache (10%)
• Nausea (5-10%, less than Strattera)
• Anxiety/jitteriness (5-10%, especially first few weeks)

Serious but rare:

• Seizures (0.4% at 300-450 mg dose, higher with eating disorders or alcohol withdrawal)

Advantages of Wellbutrin

• ✅ Treats ADHD + depression in one medication
• ✅ Not a controlled substance
• ✅ No abuse potential
• ✅ Helps with motivation and energy
• ✅ Weight neutral or slight weight loss (helpful if you gained weight on antidepressants)
• ✅ No sexual side effects (unlike SSRIs or Strattera)
• ✅ Can help with smoking cessation
• ✅ Inexpensive – generic available ($10-30/month)

Disadvantages of Wellbutrin

• ❌ Not FDA-approved for ADHD (off-label use)
• ❌ Less effective than Strattera or stimulants for ADHD
• ❌ Can worsen anxiety in some people (though helps in others)
• ❌ Insomnia risk (must take early in day)
• ❌ Seizure risk (contraindicated in eating disorders, history of seizures)
• ❌ Takes 4-8 weeks to work fully

Who Wellbutrin Works Best For

• ADHD + depression (treats both)
• Low energy, amotivation, "atypical depression"
• Smokers trying to quit (FDA-approved for smoking cessation)
• Sexual side effects from other antidepressants
• Mild-moderate ADHD in adults
• People who want an inexpensive non-controlled option

Intuniv (Guanfacine): For Hyperactivity & Emotional Regulation

Intuniv (extended-release guanfacine) is an alpha-2 agonist originally developed as a blood pressure medication. It's FDA-approved for ADHD in children and adolescents (ages 6-17), commonly used off-label in adults.

How Intuniv Works

Intuniv stimulates alpha-2A receptors in the prefrontal cortex, improving working memory and impulse control. It also reduces norepinephrine in other brain regions, which calms hyperactivity.

Effectiveness

• Response rate: 30-40%
• Best for: Hyperactivity, impulsivity, emotional dysregulation, aggression, tics
• Less effective for: Inattention (though can help when combined with stimulants)

Dosing

Starting dose: 1 mg once daily

Target dose: 2-4 mg daily

Maximum dose: 4 mg daily

Timing: Take at bedtime (causes sedation)

Side Effects

Common:

• Sedation/fatigue (40-50%, especially when starting or increasing dose)
• Low blood pressure (10-20%, can cause dizziness)
• Dry mouth (5-10%)
• Headache (10%)

Serious:

• Rebound hypertension if stopped suddenly (must taper slowly)
• Bradycardia (slow heart rate)

Advantages of Intuniv

• ✅ Reduces hyperactivity and impulsivity effectively
• ✅ Improves emotional regulation (reduces angry outbursts, frustration intolerance)
• ✅ Helps with sleep (take at bedtime)
• ✅ Reduces tics (can treat ADHD + Tourette syndrome)
• ✅ Not a controlled substance
• ✅ No abuse potential
• ✅ Works well in combination with stimulants

Disadvantages of Intuniv

• ❌ Sedation is very common
• ❌ Low blood pressure can cause dizziness
• ❌ Less effective for inattention than Strattera or stimulants
• ❌ Must taper off slowly (can't stop abruptly)
• ❌ Takes 2-4 weeks to work

Who Intuniv Works Best For

• Children/teens with hyperactive-impulsive ADHD
• ADHD + oppositional behavior, aggression, emotional outbursts
• ADHD + tics (Tourette syndrome)
• ADHD + insomnia (helps both conditions)
• As an add-on to stimulants (smooths out irritability, helps with sleep)

Qelbree (Viloxazine): The Newest FDA-Approved Option

Qelbree (viloxazine ER) is the newest non-stimulant ADHD medication, FDA-approved in 2021 for ages 6+.

How Qelbree Works

Qelbree is a norepinephrine reuptake inhibitor (NRI)—similar mechanism to Strattera, but with additional serotonin effects. The exact mechanism isn't fully understood.

Effectiveness

• Response rate: 45-55% (slightly better than Strattera in some trials)
• Effect size: Similar to Strattera (0.6-0.7)
• Time to effect: 4-6 weeks

Dosing

Starting dose: 100 mg once daily (or 200 mg for adults)

Target dose: 200-400 mg daily (adults), 100-600 mg (children, weight-based)

Maximum dose: 600 mg daily

Timing: Once daily in the morning (can take with or without food)

Side Effects

Common:

• Drowsiness (15-20%)
• Decreased appetite (10-15%)
• Nausea (10-15%, but LESS than Strattera)
• Headache (10%)
• Fatigue (10%)

Serious but rare:

• Suicidal thoughts (black box warning, like Strattera)
• Heart rhythm changes (QT prolongation, rare)

Advantages of Qelbree

• ✅ Less nausea than Strattera (major improvement)
• ✅ Not a controlled substance
• ✅ No abuse potential
• ✅ Newer option if Strattera didn't work or caused too much nausea
• ✅ Fewer GI side effects than Strattera

Disadvantages of Qelbree

• ❌ Very new (less long-term safety data)
• ❌ Expensive (no generic yet, $300-500/month, though manufacturer offers copay card)
• ❌ Takes 4-6 weeks to work
• ❌ Insurance coverage may be limited (newer medication, may require prior authorization)

Who Qelbree Works Best For

• People who tried Strattera but couldn't tolerate the nausea
• Those needing a non-stimulant with evidence specifically in ADHD
• Children and adolescents (more data in youth than adults so far)
• People who didn't respond to Strattera (different NRI, may work better)

Clonidine & Kapvay: Blood Pressure Medications for ADHD

Clonidine and its extended-release version Kapvay are alpha-2 agonists (same class as Intuniv). Originally blood pressure medications, they're FDA-approved for ADHD.

Clonidine vs. Guanfacine (Intuniv)

Very similar mechanisms and effects. Main differences:

• Clonidine: Shorter-acting, more sedating, helps more with sleep, cheaper
• Guanfacine (Intuniv): Longer-acting, less sedating, better cognitive effects, more expensive

Clonidine is less commonly used for ADHD because the sedation is more pronounced and the cognitive benefits are weaker than Intuniv. But it's a good option for:

• ADHD + severe insomnia (take at bedtime)
• ADHD + oppositional behavior in children
• Cost concerns (generic clonidine is very cheap)

Since clonidine is less commonly used as a primary ADHD medication, we'll focus the rest of this guide on Strattera, Wellbutrin, Intuniv, and Qelbree.

Side-by-Side Comparison of All Non-Stimulants

Combining Non-Stimulants with Stimulants

Many people take both a stimulant and a non-stimulant. This is called combination therapy or adjunctive treatment.

Why Combine?

• Partial response to stimulants: Stimulant helps focus during the day, but wears off by evening. Adding Strattera provides 24-hour coverage.
• Treating different symptoms: Stimulant for inattention, Intuniv for hyperactivity and emotional regulation.
• Reducing stimulant dose: Adding a non-stimulant allows using a lower stimulant dose (fewer side effects).
• Evening/nighttime coverage: Stimulants wear off by dinner. Non-stimulants continue working.
• Managing side effects: Intuniv can reduce stimulant-induced irritability and sleep problems.

Common Combinations

Safety of Combinations

Combining stimulants with non-stimulants is generally safe and well-studied. However:

• Blood pressure monitoring: Both stimulants and non-stimulants affect BP/HR—check regularly
• Increased side effects: More medications = more side effects possible
• Cost: Two medications costs more than one
• Complexity: Multiple pills to remember, more refills to manage

How to Choose the Right Non-Stimulant

Here's a decision guide based on your specific situation:

Choose Strattera if:

• You want the most evidence-based non-stimulant specifically FDA-approved for ADHD
• You have comorbid anxiety (stimulants worsen your anxiety)
• You need 24-hour coverage with consistent levels
• Inattention is your primary symptom
• You're okay with 4-6 weeks to see results
• You can tolerate nausea for the first 2 weeks

Choose Wellbutrin if:

• You have ADHD + depression (treats both)
• You need help with motivation and energy
• You want the cheapest option (generic is $10-30/month)
• You had sexual side effects from SSRIs or Strattera
• You're a smoker trying to quit
• Mild-moderate ADHD in adults (not severe symptoms)

Choose Intuniv if:

• Hyperactivity and impulsivity are your main problems
• You have emotional dysregulation (angry outbursts, frustration intolerance)
• You have insomnia (Intuniv helps sleep when taken at bedtime)
• You have tics or Tourette syndrome with ADHD
• You're adding to a stimulant (smooths out irritability)
• You can tolerate sedation/drowsiness

Choose Qelbree if:

• You tried Strattera but couldn't tolerate the nausea
• You want a newer option with potentially better tolerability
• You're a child or adolescent (more data in younger populations)
• You didn't respond to Strattera (Qelbree may work despite similar mechanism)
• Cost isn't a barrier (manufacturer copay card may help)

Switching from Stimulants to Non-Stimulants

If you're switching from a stimulant to a non-stimulant, here's what to expect:

The Process

Option 1: Gradual Crossover (Preferred)

1. Week 1-2: Start non-stimulant at low dose while continuing stimulant
2. Week 3-4: Increase non-stimulant dose, continue stimulant
3. Week 5-6: Reach target non-stimulant dose, begin reducing stimulant
4. Week 7+: Taper off stimulant completely if non-stimulant is working

Advantage: Continuous ADHD coverage, gives non-stimulant time to work before stopping stimulant

Option 2: Immediate Switch

1. Stop stimulant
2. Start non-stimulant same day
3. Wait 4-6 weeks to see if it works

Disadvantage: 4-6 weeks with poor ADHD control while waiting for non-stimulant to work

Withdrawal from Stimulants

Stimulants don't cause physical dependence, but you may experience:

• Fatigue (first few days)
• Difficulty concentrating (until non-stimulant kicks in)
• Increased appetite (rebound)
• Mood changes (irritability, depression)

This is temporary and resolves within a week.

What if the Non-Stimulant Doesn't Work?

If after 6-8 weeks at target dose you see no improvement:

• Try a different non-stimulant (e.g., Strattera → Wellbutrin)
• Consider going back to stimulants
• Try combination therapy (low-dose stimulant + non-stimulant)
• Reassess diagnosis (is it really ADHD?)

Frequently Asked Questions

Can I take non-stimulant ADHD medications while pregnant or breastfeeding?

Pregnancy: None of the non-stimulants are well-studied in pregnancy. Generally considered lower risk than stimulants, but still discuss with your OB. Wellbutrin (Category C) has the most pregnancy data. Strattera and Intuniv are also Category C.

Breastfeeding: Small amounts pass into breast milk. Risk/benefit discussion with your doctor needed.

Do non-stimulants show up on drug tests?

No. Non-stimulant ADHD medications do NOT show up on standard drug screenings. Stimulants (amphetamines) do show up, which can be problematic for some jobs or athletic competitions. This is a major advantage of non-stimulants.

Can I drink alcohol while taking non-stimulant ADHD medications?

Strattera: Alcohol may increase side effects (drowsiness, dizziness). Moderate to avoid.

Wellbutrin: Alcohol lowers seizure threshold. Avoid heavy drinking. Moderate amounts usually okay.

Intuniv: Alcohol + Intuniv both lower blood pressure → dangerous. Avoid.

Qelbree: Limited data. Moderate alcohol likely okay.

Will I build tolerance to non-stimulant ADHD medications?

No. Unlike stimulants (where some people build tolerance), non-stimulants maintain effectiveness long-term. You won't need to keep increasing the dose over time.

Can I stop non-stimulants suddenly or do I need to taper?

Strattera: Can stop suddenly (no withdrawal syndrome)

Wellbutrin: Can stop suddenly for ADHD doses, though gradual taper preferred to avoid mood dip

Intuniv: MUST taper slowly (risk of rebound high blood pressure if stopped abruptly)

Qelbree: Can stop suddenly

How long do I need to take non-stimulant ADHD medications?

ADHD is a chronic condition. Most people need medication long-term (years to lifelong). However:

• Some people's symptoms improve with age (especially hyperactivity)
• You can try reducing/stopping medication after 1-2 years of stability to see if still needed
• Non-stimulants aren't addictive, so there's no harm in taking long-term

Can children take non-stimulant ADHD medications?

Yes. All four non-stimulants (Strattera, Intuniv, Qelbree, Clonidine) are FDA-approved for children ages 6+. They're commonly used when:

• Stimulants caused too many side effects
• Family prefers non-controlled substance
• Child has tics or Tourette syndrome (Intuniv preferred)
• Severe oppositional behavior (Intuniv helps)

Are non-stimulants addictive?

No. None of the non-stimulant ADHD medications have abuse potential. They don't produce euphoria, don't cause dependence, and aren't sought by people misusing substances. This is a major safety advantage over stimulants.

Getting Non-Stimulant ADHD Treatment in NYC

Related Resources

• Complete ADHD Guide - Comprehensive resource on ADHD symptoms, diagnosis, and treatment
• ADHD Medications Overview - Stimulants vs non-stimulants comparison
• Wellbutrin for ADHD: Complete Evidence Review - Detailed analysis of bupropion for ADHD
• ADHD Psychiatrist NYC - ADHD treatment services in New York City
• ADHD in Women - Gender-specific ADHD considerations
• ADD vs ADHD - Understanding ADHD terminology

📚 Related ADHD Resources