By clicking the “I Agree” button below, you certify under penalty of perjury that the following statements are true and correct and understand that a medical provider will rely on the truthfulness of your statements when determining whether a prescription is warranted and appropriate.

I agree that I:

• am 18 years or older
• have not had a hypersensitivity reaction to viloxazine or any component of the formulation

• have a diagnosis of attention-deficit/hyperactivity disorder (ADHD) and have already been taking viloxazine as prescribed by an authorized healthcare provider
• Am taking viloxazine as prescribed for my own personal use 

• am not pregnant or breastfeeding
• will not take or have taken viloxazine concomitantly with or within 14 days of monoamine oxidase inhibitors (MAOI)
• will not take or have not taken viloxazine concomitantly with sensitive CYP1A2 substrates or CYP1A2 substrates with a narrow therapeutic range
• have already been taking the initial dose (viloxazine 100 mg) or have been previously prescribed viloxazine 150 mg or viloxazine 200 mg, if selecting viloxazine 150 mg or viloxazine 200 mg
• do not have renal (kidney) impairment or a creatinine clearance of less than 30 ml/minute.
• understand that in clinical studies, higher rates of suicidal thoughts and behavior were reported in patients with ADHD treated with viloxazine than in patients treated with placebo. Closely monitor treatment with viloxazine for clinical worsening, and for emergence of suicidal thoughts and behaviors.
• Understand viloxazine may cause fatigue, lethargy, and sedation, which may impair physical or mental abilities and to be cautioned about performing tasks that require mental alertness (eg, driving, operating machinery).
• Understand viloxazine commonly causes increased heart rate and increased diastolic blood pressure
• Understand viloxazine should be avoided in patients with bipolar disorder as it may induce a mixed or manic episode
• Will not take nor intend to take the following concurrently with viloxazine due to severe or major drug-drug interactions: agomelatine, alosetron, bendamustine, clozapine, duloxetine, fenfluramine, fezolinetant, iobenguane radiopharmaceutical products, lemborexant, lomitapide, melatonin, monoamine oxidase inhibitors, pimozide, pirfenidone, pomalidomide, propranolol, ramelteon, sirolimus, tasimelteon, theophylline, thioridazine, tizanidine, ubrogepant

• understand this is not a comprehensive list of severe or major drug interactions and I can find more information regarding drug-drug interactions at https://www.drugs.com/drug_interactions.html 

• understand this is not a comprehensive list of precautions, risks, side effects, or details about taking this medication
• understand that only major drug interactions are listed and have not been reviewed against the other medications, supplements, or herbal products I may be taking unless also filled by TelyRx