About 3 in 10 people with ADHD don’t do well on stimulants. When this happens, nonstimulants may be prescribed either alone or with another medication.
If you live with attention deficit hyperactivity disorder (ADHD) but feel like stimulant medications aren’t for you, your doctor might prescribe a nonstimulant to help manage your symptoms.
These medications include a variety of norepinephrine- and dopamine-enhancing drugs. Some of these are designed specifically for ADHD, while others are off-label medications.
Nonstimulant medications may take longer than stimulant drugs to have an effect on managing ADHD symptoms.
Stimulants, such as methylphenidate (Ritalin) or amphetamine/dextroamphetamine (Adderall), are considered the first-line treatments for ADHD.
But stimulants don’t work for everyone. For example, about
Some people with ADHD may opt for nonstimulants because:
- these drugs don’t carry the same risk for misuse as stimulants do
- they want to avoid stimulants’ side effects
- stimulant medications are ineffective at treating their symptoms
When this is the case, doctors may prescribe a nonstimulant instead. These medications range from those developed specifically for ADHD to antidepressants and other off-label prescriptions.
Sometimes, a nonstimulant is prescribed alongside a stimulant to help offset the abrupt wearing off of many stimulants.
It usually takes longer to see results from nonstimulant medications than from stimulant drugs.
People who have ADHD and take nonstimulant medications may see their symptoms improve after several weeks. So, nonstimulant medications may not be appropriate for people who need immediate ADHD symptom management.
Doctors have a variety of options when it comes to treating ADHD without the use of stimulants.
The primary nonstimulant medications for ADHD fall into one of two categories:
- norepinephrine modulators, which regulate the neurotransmitter norepinephrine
- blood pressure medications
A few drugs in these categories have been approved by the Food and Drug Administration (FDA) for ADHD treatment.
Other times, antidepressants or a specific Parkinson’s medication called amantadine are prescribed.
The primary nonstimulant medications prescribed for ADHD include:
- Atomoxetine (Strattera): norepinephrine modulator
- Viloxazine (Qelbree): norepinephrine modulator
- Clonidine (Catapres, Kapvay): alpha-agonist/ blood pressure medication
- Guanfacine (Tenex, Intuniv): alpha 2A-adrenergic receptor agonist/ blood pressure medication
- Amantadine (Symmetrel): Parkinson’s medication; originally an antiviral drug
- Antidepressants: norepinephrine dopamine reuptake inhibitors (NDRIs) and tricyclics
Atomoxetine (Strattera) was the first FDA-approved nonstimulant medication for ADHD. It’s the most commonly prescribed nonstimulant for the condition.
Atomoxetine is a norepinephrine modulator. It blocks the reuptake of the neurotransmitter norepinephrine (noradrenaline), allowing it to work longer. This action may help boost attention and reduce impulsivity and hyperactivity.
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Atomoxetine is approved for children, teens, and adults.
Common side effects
The common side effects of atomoxetine include:
- nausea and vomiting
- decreased appetite
- constipation
- headache
- dry mouth
- drowsiness
- sleep problems
- initial decrease in height and weight (which returns to normal in the long term)
- increased heart rate and blood pressure
- liver problems (in rare cases)
Viloxazine (Qelbree) is a serotonin and norepinephrine modulator recently approved by the FDA for treating ADHD in children ages 6 to 17. It’s currently being reviewed by the FDA for approval in treating ADHD in adults.
Its active ingredient (viloxazine hydrochloride) was previously used for decades as an antidepressant in Europe before being repurposed into an ADHD medication.
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Common side effects
The common side effects of viloxazine include:
- drowsiness
- decreased appetite
- fatigue
- nausea and vomiting
- irritability
- sleep problems
- increased blood pressure and heart rate
Clonidine is an alpha-agonist medication commonly prescribed to help lower high blood pressure and relax blood vessels. It’s also been shown to help treat ADHD, since it triggers the release of norepinephrine.
Kapvay, the extended-release formulation of clonidine, is FDA-approved to treat ADHD in children ages 6 to 17. It’s also prescribed for adults. Kapvay is taken to reduce impulsivity, hyperactivity, and distractibility.
Clonidine is commonly prescribed alongside a stimulant drug.
Sometimes the immediate release version (Catapres) is also prescribed off-label for ADHD.
Common side effects
The common side effects of clonidine include:
- cough
- runny nose and sneezing
- sore throat
- tiredness
- mood changes
- nightmares
- constipation
- light-headedness
Guanfacine is another blood pressure medicine (central alpha 2A-adrenergic receptor agonist) commonly prescribed to adults.
The time-release version of guanfacine (Intuniv) is FDA-approved for use in treating ADHD in children ages 6 to 17. Intuniv may help with emotional sensitivity, hyperarousal, aggression, hyperactivity, and memory.
An immediate-release form of guanfacine (Tenex) is also prescribed off-label though it’s not approved by the FDA to treat ADHD.
Common side effects
The common side effects of guanfacine include:
- dry mouth
- tiredness
- nausea
- dizziness
- sleep problems
- irritability
- reduced heart rate and blood pressure
Amantadine (Symmetrel) was originally approved in 1976 as an antiviral drug, though it’s no longer used for this purpose. Due to its dopamine-enhancing effects, an extended-release formulation was recently approved for treating dyskinesia in people with Parkinson’s disease.
Though not FDA-approved for ADHD, amantadine’s dopamine-enhancing activity may also help improve ADHD symptoms.
In a 2007 study, 24 children (ages 5 to 13) took amantadine for ADHD during a 6-week trial. It showed modest efficacy based on parent and teacher ADHD rating scales. The response rate was 58% based on parents’ and 46% based on teachers’ ratings.
A subsequent 6-week trial of 40 children (28 boys and 12 girls) looked at the effectiveness of amantadine compared with methylphenidate. The findings showed similar efficacy between the two drugs, and any differences were considered nonsignificant.
In addition, the amantadine group reported fewer side effects of decreased appetite and restlessness compared to the stimulant group.
This study was critiqued for not having a placebo group, as well as for its short duration. However, the authors argued that their use of methylphenidate (which is known to be effective in this disorder) in a control group was an acceptable alternative to having a placebo group.
Common side effects
The common side effects of amantadine include:
- dry mouth
- nausea
- blurred vision
- light-headedness
- insomnia
Antidepressants are not FDA-approved to treat ADHD, but NDRIs (norepinephrine dopamine reuptake inhibitors) and tricyclics are sometimes prescribed for ADHD off-label. These medications may help increase norepinephrine and/or dopamine, which are low in people with ADHD.
The most commonly prescribed antidepressant for ADHD is the NDRI bupropion (Wellbutrin), which slows the reabsorption of dopamine and norepinephrine in the brain.
Tricyclic antidepressants, including desipramine (Norpramin, Pertofrane) and imipramine (Tofranil), may also help improve ADHD symptoms in children and adults who don’t respond to stimulants.
Research from 2014 suggests that tricyclics, particularly desipramine, may help improve symptoms for children and adolescents with ADHD in the short term.
However, these medications are known to have more difficult side effects in some people (especially those with heart problems), which may limit their use.
Antidepressants may also be prescribed alongside a stimulant to help with comorbid depressive symptoms.
Common side effects
The common side effects of antidepressants include:
- sleepiness
- weight gain
- nausea and vomiting
- diarrhea
Not everyone with ADHD responds well to stimulants. In these cases, nonstimulants may be prescribed either alone or alongside another medication.
Nonstimulants range from those developed specifically for ADHD to antidepressants and other off-label prescriptions.
Nonstimulants tend to take longer to show results than stimulants. So, nonstimulant drugs may not be appropriate for those who need to manage their symptoms urgently.
If you have ADHD and are interested in alternatives to stimulants, you can talk with your doctor about your options.