31.18d Pharmacotherapy
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Table 31.18d-2
Pharmacologic Agents for Psychiatric Disorders in Children Adolescents
Drug
Indications
Dosage
Adverse Reactions
Antipsychotics
Risperidone (Risperdal),
Olanzapine (Zyprexa),
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Clozapine (Clozaril)
Haloperidol (Haldol)
Psychosis; agitation self-
injurious behaviors
aggression
Tics
Clozapine-refractory
schizophrenia in
adolescents
Risperidone 1–4 mg per day
Olanzapine 2.5–10 mg per day
Quetiapine 25–500 mg per day
Aripiprazole 2–20 mg per day
Ziprasidone up to 160 mg per
day
Clozapine
<
600 mg per day
Haloperidol up to 10 mg per day
Sedation, weight gain,
hypotension, lowered seizure
threshold, constipation,
extrapyramidal symptoms,
jaundice, agranulocytosis,
dystonic reaction, tardive
dyskinesia
Hyperprolactinemia
Monitor
blood pressure, CBC LFTs,
prolactin Clozapine: weekly
WBC
Stimulants
Dextroamphetamine
and Amphetamine
(Dexedrine spansule)
Mixed Amphetamine
Salts (Adderall) FDA
approved for 3 years
and older
Adderall XR
Lisdexamfetamine
(Vyvanse)
Methylphenidate
Ritalin
Ritalin SR
Concerta
ADHD hyperactivity,
impulsivity, and
inattentiveness
Narcolepsy
Dextroamphetamine 5–40 mg
per d
0.25 mg/kg/dose
FDA max 40 mg per day
5–40 mg per d
Or 0.25 mg/kg/dose
FDA approved max
40 mg per day
5–30 mg per day
FDA approved max
30 mg per day
20–70 mg per day
FDA approved max
70 mg per day
Methylphenidate—10–60 mg
per day or up to 0.5 mg/kg
per dose FDA approved max
60 mg per day
FDA approved max 54 mg per
day for children; 72 mg per
day for adolescents
Insomnia, anorexia, weight
loss (possibly growth delay),
rebound hyperactivity,
headache, tachycardia,
precipitation or exacerbation
of tic disorders
Daytrana patch
Focalin XR
FDA approved max 30 mg per
day Patch worn
9 hours per day
FDA approved max
20 mg per day
Skin irritation
Non-stimulants
Atomoxetine (Straterra)
ADHD
Begin with 0.5 mg/kg Up to
1.4 mg/kg
Or 100 mg, whichever is less
Abdominal pain Loss of appetite
Mood stabilizers
Lithium—antiaggression
properties
Studies support use in MR and
CD for aggressive and self-
injurious behaviors; can be
used for same in PDD; also
indicated for early-onset
bipolar disorder
600–2,100 mg in two or three
divided doses; keep blood
levels to 0.4–1.2 mEq/L
Nausea, vomiting, polyuria,
headache, tremor, weight gain,
hypothyroidism
Experience with adults suggests
renal function monitoring
Divalproex (Depakote)
Bipolar disorder, aggression Up to about 20 mg/kg per day;
therapeutic blood level range
appears to be 50–100
m
g/mL
Monitor CBC count and LFTs for
possible blood dyscrasias and
hepatotoxicity
Nausea, vomiting, sedation, hair
loss, weight gain, possibly
polycystic ovaries
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