ADHD Pharmacotherapy
Class /DosesFDA Off-LabelComments
Namemax/dMax/day
Amphetamines
Short-Acting
Adderall5,7.5,10,12.5,40mg>50kg: 60mgindicated
15,20,30mgfor 3-5yo
Dexedrine5mg
Dextrostat5, 10mg
Long-Acting
Dexedrine5,10,15mg40mg>50kg; 60mg
Spansules
Adderall XR5,10,15,2030mg>50kg: 60mg can be opened up
15,30mgand sprinkled
50/50 delivery
Lisdexamfetamine 20,30,40,5070mg? > 70mgpro-drug,
(Vyvanse) 60, 70mgdissolvable,
lasts up to 14hrs
Methylphenidates
Short-Acting
Ritalin5,10,20mg60g>50kg; 100mg
Methyline5,10,20mg tab60mg>50kg; 100mg liquid also avail
Focalin2.5,5, 10mg cap20mg50mg
Intermediate-Acting
Meetadate ER10,20mg cap60mg>50kg: 100mgwax
Methylin ER10,20mg cap60mg>50kg: 100mgwax
Ritalin SR20mg60mg>50kg: 100mgwax
Metdate CD10,20,30,4060mg>50kg; 100mgcan be sprinkled
50, 60mg30/70 delivery
Ritalin LA10,20,30,40mg60mg>50kg: 100mgcan be sprinkled
50/50 delivery
Long-Acting
Concerta18,27,36,54mg72mg108mgTriphasic, tiered delivery, @ 12hrs
Daytrana10,15,20, 30mg30mg? 40mgPatch
Patchpatches
Focalin XR5,10,15,20,30-40mg50mg
30, 40mg
Stimulant-Like:
Provigil100, 200mg400ng.d400mgusually only for sleep disorders
ADHD Pharmacotherapy
Class /DosesFDA Off-LabelComments
Namemax/dMax/day
Selective Norepinephrine Reuptake Inhibitor
Atomoxetine10,18,25,40,60,1.4mg/kg1.8mg/kgcan help anxiety,
Stratterra80, 100mgor 100mgor 100mg?sleep; often used with tics, for
College/adults
Antidepressants
Buproprion
Wellbutrin75, 100mg6mg/kg or 300mglowers seizure not >150mg/dose threshold, up to 3x/day
Wellbutrin SR100,150,200mg400mg/daybid dosing
Wellbutrin XL150,300mgup to 450mgonce daily
Imipramine
Tofranil10,25,504mg/kg or 200mggood for enuresis
75mg tabbaseline /monitor
EKG
Nortriptyline
Pamelor,10,25,50,2mg/kg or 100mgbaseline EKG
Aventil75mg cap
Alpha-Agonists
Clonidine 0.1,0.2,0.3mg27-40.5kg: 0.2mgqid for all day
Catapres40.5-45kg: 0.3mgcontrol; used in
>45kg: 0.4mgcombination;
for tics, ? PTSD
Clonidine ER 0.1, 0.2mgup to 0.4mg/dayjust approved
Kapvayusually bid
Guanfacine1,2mg27-40.5kg: 2mgbid-tid dosing
Tenex40.5-45kg: 3mggood for PTSD,
>45kg: 4mgtics
Guanfacine ER 1,2,3,4mg<50lb: 1mggood for ODD
Intuniv50-90lb: 2mgcombination tx
90-130ob: 3mg24hr duration
>130: 4mg
up to 0.13mg/kg
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Anxiolytics
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Buspirone5, 7.5,10,15,305-60mg, bidmight help PDD
Buspardividosemax 60mgdisruptive bx
SSRI antidepressants are first line pharmacotherapy for anxiety disorders. Treatments decisions are often based on the co-morbid ailment and the side-effect profile. Strattera, for instance, might treat both ADHD and anxiety rather than being on a stimulant plus an SSRI.
Antidepressants
Class /DosesDosing Comments
Name
SSRI
Fluoxetine10,20,40mg cap10-80mgonly one indicated depression in Prozac 20mg/5ml solution children
90mg weekly dose
Sertraline25,50,100mg cap25-200mgOCD, ? PTSD
Zoloft20mg/ml solution
Citalopram10, 20, 40mg tab10-60mgnot FDA approved in kids
Celexa10mg/5ml solution
Escitalopram5,10,20mg5-30mgadolescent depression
Lexapro
Fluovoxamine25, 50,100mg tab25mg qhsOCD
Luvoxrange 50-200
Luvox CR100,150mg300mg max
Paroxetine10,20,30,40mg10-60mgOCD, withdrawal symptoms
Paxil10mg/5ml solution
Paxil CR12.5,25,37.525-75mgextended release
SNRI
Venlafaxine
Effexor25,37.5,50,75,100mg37.5-375mg? ADHD applications, monitor for
Effexor XR37.5,75,150mg37.5-225mgwithdrawal (malaise)
Desvenlafaxine50,100mg50-200mg/dsimilar to Effexor, but less w/d
Pristiq
Duloxetine20,30,60mg20-60bid? ADHD; fibromyalgia/pain
Cymbalta120max
Other:
Buproprion
Wellbutrin75,100mgtid dosing, up to 300mglowers sz threshold
Wellbutrin SR 100,150,200mgbid dosing, up to 400mg
Wellbutrin Xl150,300mgqd dosing, up to 450mg
Trazodone50,100,150,300mg50-300mg qhs for insomnia
Risk of priapism
Mirtazapine15,30,45mg15-60mg qhsincrease sleep, appetite
Remerongood for anxiety/insomnia
Remeron 15,30,45mg15-60mg qhs dissolvable tablet
SolTab
Tricyclincs:
Clomipramine20,30,60mg capstart 25mg/d,OCD, enuresis
Anafranilmax 3mg/kg/d or 200mgADHD
Imipramine25,50,100mg tab6-12y: 2.5mg/kg/d or 50mg
Tofranil75,100,125,150mg cap>12y: 75mg Enuresis, ADHD
Overall useful in mood disorders, ADHD, enuresis, tic and anxiety disorders. FDA recommends close monitoring of children and adolescents after starting antidepressants or increasing dosage for concerns of increased suicidality, for which all antidepressants carry a Black Box Warning. Baseling EKG is recommended for tricyclic antidepressants. MOAIs (not included above) are problematic in children for the strict dietary restrictions. Monitor BP and cardiac status with venlafaxine.
Mood Stabilizers
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Class /DosesDosing Comments
Name
Lithium150,300,600mg15-60mg/kg, divided decrease mania/suicide
300,450mg ERmax 2.5mg/day many SE- tremor, thyroid
300mg/5ml liquid or 900mg ER bidoptimum blood level 1.
Requires lab monitoring
Anticonvulstants
Valproic Acid250mg, 250/5ml 125-750mg bidadult bipolar indication
Depakote125,250,500blood level 80-100worsen irritability
Depakote ER250,500mg ERrequires lab monitoring
Dep Sprinkles125mg
Lamotrigine25,100,150,200mg25-150mg bidToxic rash
Lamictal25,50,100,200mg ODTadult bipolar indication
2,5,25mg CHgood for bipolar dep
Oxcarbamazepine 150,300,600mg150-600mg bidoff-label use
Trileptal 300mg/5mlsedation, hyponatremia
Topiramate25,50,100,200mg tab50-100mg bidoff label, wt loss
Topamax15,25mg capup to 200mg bidcognitive dulling
Gabapentin100,300,400,600100mg bid, tidoff label
Neurontin800mg; 50mg/mlup to 600mg tidgood for anxiety
Atypical Antipsychotics
Risperidone0.25,0.5,1,2,3,40.25qhs-bidapproved in Autism/PDD
Risperdal1mg/ml; m-tabto 4mg bidchildren >10yo for mania
Wt, sedation, prolactin
Aripiprazole2,5,10,15,202-30mg qd/bidwt neutral?
Abilify30mg; 1mg/mlavg 10mg DA partial agonist
Discmelt10,15mg ODT ?restlessness/dystonia
PDD/Autism indication
Olanzapine2.5,5,7.5,10,2.5-30mgsedation, wt gain.
Zyprexa15,20mgpediatric bipolar
Zydis5,10,15,20mg ODT
Quetiapine25,50,100,200,25-800mg qhssedating, good for
Seroquel300,400mg nightmares
Seroqule XR50,150,200,300,not app for child/adol
400mg ER
Ziprasidone20,40,60,80mg20-80mg bidwt neutral,
Geodonenot approved child/adol
QT prolongation
Mood stabilizers are beneficial in aggression, psychosis, self-injurious behaviors related to developmental disorders, and tic disorders. They can also be used to augment antidepressant effects for treatment resistance.