Retrospective Study of Psychiatric Medication Burden in Adults with ADHD Receiving a Therapeutic Regimen Including Psychostimulants and Viloxazine Extended-Release Capsules

OBJECTIVE: Viloxazine extended-release (VLX-ER) is a nonstimulant FDA-approved medication for pediatric and adult ADHD treatment. Patients with ADHD often have psychiatric comorbidities, and may sometimes also have complex psychiatric drug regimens. We investigated the safety, efficacy, and impact on psychiatric medication burden when incorporating VLX-ER into ADHD treatment regimens.
METHODS: This was a retrospective study of adults with ADHD from a group psychiatric practice who were taking psychostimulants and/or other psychiatric medications prior to starting treatment with VLX-ER. Patients who filled ≥2 prescriptions for VLX-ER were included (n=70; 41.4% female, 55.7% male, 2.9% nonbinary; 37 ± 13.9 years (mean age ± SD)). Paired-sample t-tests measured changes in medication burden, efficacy measures, and adverse experience survey responses at baseline and endpoint (2-3 visits after VLX-ER initiation).
RESULTS: Stimulant dosage decreased by (mean ± SD) 26±30mg (calculated relative to 1mg base amphetamine) from baseline 37±26.6mg (p < 0.025; n=29). Statistically significant decreases (p < 0.025) were also observed in immediate-release stimulant booster presence, number of other psychiatric medications, and number of controlled substances; changes in sleep medications and benzodiazepines were nonsignificant. ADHD symptoms, measured using the ASSET severity score, improved -0.68 ± 0.87 from baseline 3.81 ± 0.97 (p < 0.025; n=44). No surveyed adverse event showed statistically significant worsening, with fatigue and anger showing significant improvement relative to baseline (p < 0.025).
CONCLUSIONS: Although preliminary, this retrospective study suggests that for adults with ADHD, treatment with viloxazine ER might allow for reduction in stimulants and/or psychiatric medications without apparent loss of ADHD treatment efficacy or tolerability.