Non-stimulant medication
Non-stimulant medicines work differently from stimulant ADHD medicines and usually take longer to show their full effect.
For adults, NICE recommends atomoxetine when methylphenidate and lisdexamfetamine are not tolerated or have not produced an adequate response. Guanfacine has a different place in treatment and is principally used in children and young people.
Atomoxetine
Atomoxetine is a non-stimulant medicine. In adults, NICE places it after appropriate trials of methylphenidate and lisdexamfetamine when these are not tolerated or have not produced enough benefit.
It does not have the same immediate onset pattern as stimulants, so response is judged over a different timescale.
Guanfacine
Guanfacine is another non-stimulant option used mainly in children and young people. NICE recommends atomoxetine or guanfacine for children aged 5 years and over and young people when stimulant treatment is not tolerated or has not been sufficiently effective after appropriate trials.
NICE advises that guanfacine for adults should not be offered without advice from a tertiary ADHD service.
Why might a non-stimulant be considered?
Reasons can include inadequate response to stimulants, adverse effects, clinical contraindications, misuse/diversion concerns or an informed treatment decision made with the specialist. The choice is individual and should not be reduced to a simple “stronger versus weaker” comparison.