Atomoxetine and viloxazine can improve your ability to start tasks, stay focused, and block distractions, says Sparacino. Guanfacine ER and clonidine ER are often used to manage impulsive reactions like blurting or snapping.
Larson notes that guanfacine ER and clonidine ER are officially approved for ADHD in children ages 6 to 17, but in adults they’re sometimes prescribed off‑label when stimulants aren’t a good option.
Side Effects of Nonstimulants for ADHD
Nonstimulants generally cause milder side effects than stimulants, and many of the side effects improve in a few weeks, says Larson. Common side effects include:
- Nausea
- Stomach upset
- Decreased appetite
- Sleep changes, including trouble falling asleep or feeling drowsy
- Dry mouth
- Dizziness or lightheadedness
- Fatigue or sedation, especially with guanfacine or clonidine
- Lower blood pressure or slower heart rate
- Mild increase in heart rate or blood pressure with atomoxetine or viloxazine
- Constipation
- Sexual side effects in some adults
Talk with your healthcare provider if side effects are persistent and bothersome, or if you notice significant changes in mood, like new or worsening depression or agitation, says Sparacino.
Some people experience increased irritability or depressive symptoms while taking atomoxetine, says Larson. Any persistent worsening of mood or suicidal thoughts means it’s time to talk to your healthcare provider.
Larson also notes that atomoxetine carries a rare risk of liver damage, which may appear as yellowing of the skin or dark urine, and it should be stopped right away if these symptoms occur.
Who Shouldn’t Take Nonstimulants
Providers may avoid or use nonstimulants cautiously in people who have:
- Significant cardiovascular disease, including serious heart rhythm problems, very low blood pressure, a recent heart attack, severe heart failure, or certain heart conditions
- Pheochromocytoma (a type of tumor in the adrenal glands)
- Bipolar disorder or psychotic disorders
- Severe liver disease
- Glaucoma
“People with complex medical or mental health histories should work closely with a prescriber who can choose the safest medication and monitor symptoms over time,” says Sparacino.
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