Non-Stimulant ADHD Medication

What non-stimulant medication is

Non-stimulants are the second group of medicines used to treat ADHD in the UK. They work on the same chemical messengers as the stimulants, principally noradrenaline, but by different mechanisms and over a much longer timescale. Our guide to ADHD medication in the UK sets out how the two groups compare.

The defining difference is patience. A stimulant tells you within a day or two whether a dose is working. A non-stimulant builds over four to eight weeks and cannot be judged after one. Titration is slower, but the effect is continuous rather than arriving in the morning and wearing off at night.

Because they are not controlled drugs, the practical side of prescribing is simpler: no monthly prescribing cycle, no identification checks at the pharmacy, and fewer complications when travelling. For some people that alone is a meaningful advantage.

The non-stimulant options

Two are licensed for ADHD in the UK. Two more are used off-label.

• Atomoxetine (Strattera)

  A noradrenaline reuptake inhibitor, licensed for children from six and for adults.

  24 hours, 4 to 8 weeks to full effect

• Guanfacine (Intuniv)

  An alpha-2A agonist, licensed for children and adolescents where stimulants are unsuitable.

  24 hours

Clonidine

Clonidine is used less often and is not licensed for ADHD in the UK, so its use here is off-label and a specialist decision. It works on a similar receptor system to guanfacine and is sometimes considered where sleep difficulty or tics are a prominent part of the picture. Like guanfacine, it should not be stopped abruptly.

Bupropion

Bupropion is a noradrenaline and dopamine reuptake inhibitor. In the UK it is licensed as Zyban for smoking cessation, not for ADHD, so ADHD use is off-label and a specialist decision. Trial evidence supports a modest effect on adult ADHD symptoms, and it is most often considered where depression sits alongside ADHD or where the licensed options have not suited.

It carries its own cautions. Bupropion lowers the seizure threshold, so it is avoided where there is a history of seizures, an eating disorder, or heavy drinking. Blood pressure is monitored, sleep can be disturbed if it is taken late, and it is not combined with monoamine oxidase inhibitors.

Who non-stimulants are prescribed for

There are several situations where a non-stimulant is the better starting point rather than a fallback.

• Where a stimulant has been tried at an adequate dose and has not helped enough
• Where stimulant side effects, particularly on sleep or appetite, were not tolerable
• Where there is a heart condition or another reason a stimulant is unsuitable
• Where tics are prominent, in which case guanfacine is sometimes preferred
• Where a controlled drug creates real practical difficulty
• Where continuous evening and overnight cover matters more than daytime peak effect

They are also sometimes chosen where an anxiety disorder sits alongside ADHD, since stimulants can occasionally sharpen anxiety in the first weeks. That is not a rule, but it is one of the factors weighed in the decision.

As with any ADHD medication, the decision follows a full assessment and is made with a Consultant Psychiatrist. Pulse and blood pressure are checked before starting, and guanfacine in particular needs blood pressure monitored during treatment because it lowers it.

Side effects

The side effect profile differs from the stimulants, which is often the reason for choosing one. Our general guide to ADHD medication side effects covers all the licensed options.

Atomoxetine

• Nausea and stomach discomfort, particularly early on
• Reduced appetite
• Dry mouth
• Tiredness or sleepiness
• Mood changes, which should be reported promptly
• A modest rise in heart rate or blood pressure

Guanfacine

• Drowsiness and tiredness, especially in the first weeks
• Headache
• Stomach pain
• Lowered blood pressure and slowed heart rate
• Dizziness, particularly on standing up quickly

Bupropion

• Difficulty sleeping, particularly if taken late in the day
• Dry mouth
• Headache
• Nausea
• Agitation or restlessness
• A rise in blood pressure
• Seizures, which are rare but are the reason for the prescribing cautions

• Appetite and weight Why it happens and how it is managed
• Anxiety Whether medication helps or makes it worse
• Alcohol Risks and practical guidance

What the first few weeks look like

The build-up is the part worth preparing for. Atomoxetine is usually started at a lower dose for the first week or so and then increased, and the full effect is not expected for four to eight weeks. Guanfacine is titrated upwards in weekly steps with blood pressure and pulse checked as the dose rises.

Early side effects often arrive before any benefit does, which is an uncomfortable order. Nausea with atomoxetine and drowsiness with guanfacine are most noticeable in the first fortnight and usually settle. Knowing that in advance is the difference between waiting it out and abandoning a medicine that would have suited.

Timing helps. Atomoxetine taken with food is often better tolerated, and guanfacine taken in the evening moves the drowsiness to a time when it matters less. Both are worth raising at review rather than enduring, because small adjustments frequently solve them.

Keeping a brief record through this period beats trying to recall it at an appointment. A line a day on sleep, appetite and how the afternoon went gives a prescriber something concrete to work from.

How they compare with stimulants

The two groups differ on speed, cover and regulation rather than on quality.

Scroll the table sideways to see every column.

The slower onset is the trade-off people notice most. Stopping early because nothing has happened by week two is the most common reason a non-stimulant is written off before it has had a chance to work.

There is also a difference in how the two groups feel to take. A stimulant has a shape to the day: it comes on, holds, and eases off. A non-stimulant has no shape, and once established people frequently say they stop noticing it at all, recognising the benefit only when they miss a few days. Against that, continuous cover suits some people much better: no afternoon drop-off to plan around, and evenings no different from mornings.

Combining a stimulant and a non-stimulant

Not a routine starting point, but a recognised option where one medicine has done half the job.

Treatment is not always a choice between the two groups. Where a stimulant has given a clear but partial response, a specialist may add a non-stimulant alongside it rather than switch: the stimulant shapes the working day, and the non-stimulant provides continuous cover underneath it. The situations where it is considered are fairly specific.

• A stimulant works well but wears off before the evening, and a longer or later dose is not tolerated
• Core symptoms respond but emotional regulation, sleep onset or tics do not
• The stimulant dose that would be needed for a full response is not tolerable, so a lower dose is combined with something else
• Guanfacine or clonidine is added at night where getting to sleep is the remaining problem

The trade-offs are real. Two medicines mean two side effect profiles and more difficulty working out which one is responsible when something changes. Pulse and blood pressure are watched more closely, because a stimulant raises both and guanfacine and clonidine lower them, which is why combinations are introduced one change at a time.

This is a specialist decision, made and reviewed by a Consultant Psychiatrist. It is not a step to take before a single medicine has had a fair trial: our guide to titration covers what an adequate trial looks like.

Getting a non-stimulant prescribed

The pathway is the same as for any ADHD medication. A GP cannot start treatment. It has to be initiated by a specialist, such as a Consultant Psychiatrist, following a full assessment. Once the dose is stable, prescribing can sometimes transfer to a GP under a shared care agreement, although a practice can decline.

Because non-stimulants are not controlled drugs, prescriptions can be issued as repeats covering more than a month, which makes the ongoing arrangement simpler once you are established.

• How to get ADHD medication in the UK The full pathway, NHS and private
• How titration works Finding the right dose, and how long it takes
• What ADHD medication costs NHS prescription charges and private prices

Common questions