Selective norepinephrine reuptake inhibitor (NRI), non-stimulant
Selectively inhibits presynaptic norepinephrine transporter, increasing norepinephrine levels in the prefrontal cortex, enhancing attention and executive function
Attention-deficit/hyperactivity disorder (ADHD)
Executive dysfunction, augmentation in depression, emotional dysregulation in autism spectrum disorder (ASD), fatigue and cognitive slowing following traumatic brain injury (TBI)
Oral capsules
40 mg once daily; may be increased after 3–7 days, divided dosing (BID) possible
40–100 mg/day
Metabolized by CYP2D6; half-life ~5 hours (longer in poor metabolizers); steady state in 2–3 days
Dry mouth, nausea, decreased appetite, insomnia, dizziness, increased heart rate and blood pressure
Rare hepatotoxicity; monitor liver function tests if clinically indicated; possible mood activation or irritability
Blood pressure, heart rate, mood changes, liver function tests if symptomatic
Suicidal ideation risk in children and adolescents
May improve apathy, attention deficits, and slowed processing in patients with TBI, stroke, or Parkinson’s disease (PD). Considered lower risk for misuse or dependence, making it preferable in patients with substance use history. Use caution and monitor cardiovascular status in patients with underlying cardiac disease.