Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 31: Child Psychiatry

Table 31.18d-2 Pharmacologic Agents for Psychiatric Disorders in Children Adolescents ( continued )

Drug

Indications

Dosage

Adverse Reactions

Antidepressants Tricyclic antidepressants clomipramine (Anafranil)

Major depressive disorder, separation anxiety disorder, bulimia nervosa, enuresis; sometimes used in ADHD, sleepwalking disorder, and sleep terror disorder Clomipramine is effective in childhood OCD and sometimes in PDD OCD, Anxiety Disorders, Depressive disorders Bulimia

eventually combine in one dose, which is usually 50–100 mg before sleep Clomipramine—start at 50 mg per day; can raise to not more than 3 mg/kg per day or 200 mg per day

Dry mouth, constipation, tachycardia, arrhythmia

Selective serotonin reuptake inhibitors — fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), citalopram (Celexa) Bupropion (Wellbutrin)

Less than adult dosages

Nausea, headache, nervousness, insomnia, dry mouth, diarrhea, drowsiness, disinhibition

ADHD

Start 50 mg and titrate up to between 100 and 250 mg per day

Disinhibition, insomnia, dry mouth, gastrointestinal problems, tremor, seizures

Anxiolytics Benzodiazepines Clonazepam (Klonopin)

Panic disorder, generalized anxiety disorder Separation anxiety disorder Various anxiety disorders

0.5–2.0 mg per d

Drowsiness, disinhibition

Alprazolam (Xanax) Buspirone (BuSpar)

Up to 1.5 mg per day 15–90 mg per day

Drowsiness, disinhibition Dizziness, upset stomach

a 2

-Adrenergic receptor agonists

Clonidine (Catapres)

ADHD, Tourette’s disorder, aggression

Up to 0.4 mg per day

Bradycardia, arrhythmia, hypertension, withdrawal hypotension Same as with clonidine plus headache, stomachache

Guanfacine (Tenex)

ADHD

0.5–3.0 mg per day

b -Adrenergic receptor antagonist (beta blocker) Propranolol (Inderal)

Explosive aggression

Start at 20–30 mg per day, and titrate

Monitor for bradycardia, hypotension, bronchoconstriction Contraindicated in asthma and diabetes

Other agents Desmopressin (DDAVP)

20–40 m g intranasally

Nocturnal enuresis

Headache, nasal congestion, hyponatremic seizures (rare)

Table by Richard Perry, M.D.

etine is well absorbed after ingestion and reaches its maximal plasma concentration after about 1 to 2 hours. Common side effects of atomoxetine include abdominal discomfort, decreased appetite, dizziness, and irritability. Rarely, minor increases in blood pressure and heart rate have been noted. Atomoxetine is metabolized by the cytochrome P450 (CYP) 2D6 hepatic enzyme system, and a fraction of the population (about 7 per- cent of Caucasians and 2 percent of African Americans) are poor metabolizers, which may increase the plasma half-life by about fivefold. When combined with other medications that inhibit CYP 2D6, such as fluoxetine and paroxetine, diminished metabolism of atomoxetine can occur, and the dose may need to be decreased. Atomoxetine is generally initiated at 0.5 mg/kg

were decreased appetite, headache, insomnia, decreased weight, and irritability. Recent studies support the use of atomoxetine (Strattera), a norepinephrine reuptake inhibitor, as an efficacious nonstimu- lant treatment for ADHD in children and adolescents. Atomox-

Table 31.18d-3 Common Dose-Related Side Effects of Stimulants

Insomnia Decreased appetite Irritability or nervousness Weight loss