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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
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)
OCD, Anxiety Disorders,
Depressive disorders
Bulimia
Less than adult dosages
Nausea, headache, nervousness,
insomnia, dry mouth, diarrhea,
drowsiness, disinhibition
Bupropion
(Wellbutrin)
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
0.5–2.0 mg per d
Drowsiness, disinhibition
Alprazolam (Xanax)
Separation anxiety disorder
Up to 1.5 mg per day
Drowsiness, disinhibition
Buspirone (BuSpar)
Various anxiety disorders
15–90 mg per day
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
Guanfacine (Tenex)
ADHD
0.5–3.0 mg per day
Same as with clonidine plus
headache, stomachache
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)
Nocturnal enuresis
20–40
m
g intranasally
Headache, nasal congestion,
hyponatremic seizures (rare)
Table by Richard Perry, M.D.
Table 31.18d-3
Common Dose-Related Side Effects of Stimulants
Insomnia
Decreased appetite
Irritability or nervousness
Weight loss
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-
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
