Emerging treatments

Guanfacine

Guanfacine is an alpha-adrenergic agonist that is typically used in children with attention deficit hyperactivity disorder (ADHD) who have not responded to or who cannot tolerate stimulant medications or atomoxetine. In children, a number of randomised controlled trials have demonstrated efficacy of guanfacine compared to placebo, and the available evidence suggests an acceptable safety profile.[137][138]​​​ In adults, evidence on guanfacine is limited and more studies are needed before its use can be recommended as part of standard practice in this population group.[139] In adults, guanfacine is associated with a number of adverse effects, including hypotension, somnolence, postural dizziness, and constipation.[140]

Viloxazine

Viloxazine is a selective noradrenaline-reuptake inhibitor that was initially developed as an antidepressant in the 1970s. An extended-release formulation of viloxazine was approved for the treatment of ADHD in children aged 6 to 17 years in the US in 2021. It has now also been approved for the treatment of ADHD in adults, and is the first novel non-stimulant option to be approved in the US for ADHD in adults in 20 years. In phase 3 clinical trials, viloxazine improved ADHD symptoms compared to placebo and was generally well tolerated. Somnolence, decreased appetite, and headache were the most commonly reported adverse events.[141][142][143][144] Based on clinical study data, viloxazine is associated with an increased risk of suicidal thoughts and behaviour compared to placebo. Patients treated with viloxazine therefore need to be closely monitored for clinical worsening, and for emergence of suicidal thoughts and behaviours. Viloxazine is not approved or available in Europe.

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