Microsoft word - med_ref_guide_children.doc

Medication Reference Guide for Children and Adolescents
By Dr. Steven Lopez

Steven Lopez, MD is the Chief Medical Officer for Palmetto Behavioral Health. Dr. Lopez
completed his residency program in adult psychiatry at The Medical University of South
Carolina in 2000 and completed his fellowship in child and adolescent psychiatry in
2001.
He is Board Certified with the American Board of Psychiatry and Neurology and is a
member of the American Psychiatric Association and the American Academy of Child
and Adolescent Psychiatry. He has a special interest in childhood disorders including
Autism.

GROUP 1: ADHD

Stimulants (Methyphenadate products)

Methylphenidate is a central nervous system (CNS) stimulant that reduces impulsive
behavior, and helps to improve concentration at school, work and other tasks.
Methylphenidate is a norepinephrine and dopamine reuptake inhibitor, which means that
it increases the level of the dopamine neurotransmitter in the brain by partially blocking
the dopamine transporter that removes dopamine from the synapses.
‐ Each child is unique, and as a result, there is no way to tell what medication will ‐ All have similar side effects such as headaches, stomach aches, and appetite ‐ It is always good medical practice to check weight, blood pressure etc… when a Adderall: This stimulant targets epinephrine levels more than some of the other stimulants. (80 dop, 20 epinephrine) Studies have shown that Adderall is more potent than Ritalin and has a longer period of efficaciousness. It is also a good substitute for children who have adverse side effects to Ritalin, or for whom Ritalin has become ineffective. A dose remains active in the body longer than a dose of Ritalin. Some patients also feel that it has less of a drop off effect than Ritalin. Metadate: Metadate is a reformulation of Ritalin for sustained delivery. One difference is that it may kick in faster than some of the other stimulants. Because Metadate releases over several hours it can deliver a smoother dose throughout the day and lasts up to 8 hours. Like Ritalin the most common side effects reported were headache, loss of appetite, abdominal pain and insomnia. Metadate is also very similar to Adderall, and Concerta. Concerta: This is also a reformulation of Ritalin, yet it tends to offer more of a smooth release throughout the day. It lasts 6-8 hours. Ritalin: The most prevalant of the stimulant medications. It targets itself more towards dopamine levels (90 dop – 10 epinephrine split) and is shorter acting at 4-6 hrs. It is good for targeted hours/activities during the day to help a child with concentration and impulsivity.
Vyvanse:
This is newest of all the medications in this group. It marks a significant change in that it
uses a different type of stimulant than other medications. It has a long duration and is
especially formulated to prevent substance abuse.
It is a pro-drug meaning that the active ingredient is released in the stomach. This is
different than traditional ADHD medications in that it is inert until it is digested. This
mimics how the body creates useful chemical and vitamins from our food. As Vyvanse
only acts as a stimulant once it is broken down by the stomach you cannot get a high
from grinding it up and snorting it.
It last 8-10 hrs
Non Stimulants

Strattera:
This is a long acting non-stimulant that takes about 2-3 weeks to start working. A child
can experience some sedation as a side effect.
It is classified as a norepinephrine (noradrenaline) reuptake inhibitor. One of it’s
advantages over stimulants for the treatment of ADHD is that it has less abuse potential
than stimulants and it can also help with anxiety symptoms.
GROUP 2: Depression & Anxiety

SSRI’s

Selective serotonin reuptake inhibitors (SSRIs) are a newer class of antidepressant
medications. SSRI’s increase seratonin in the brain. The first drug in this class was
fluoxetine (Prozac), which hit the U.S. market in 1987.
SSRIs are generally considered safer than other classes of antidepressants. They're
less likely to have adverse interactions with other medications, and they're less
dangerous if taken as an overdose. All SSRIs have the same general mechanism of
action and side effects. However, when prescribed all phsyicians are required to issue
the FDA warning in order to ensure full consent from families as there may be a small %
of children who may experience an increase in suicidality.
The SSRI’s are particularly helpful in heading off depression especially in the early
stages. Some studies suggest that SSRI’s are ideal for those people with minor
depressive illness and that they may be better than tricyclics and MAOI’s in this regard.
The SSRI’s are also effective for major depression.

Prozac:
It is more of an activator which can be very effective for children who are profoundly
psychologically depressed. There also tends to be less risk of withdrawal when you stop
this medication.
The antidepressant, antiobsessive-compulsive, and antibulimic actions of Prozac are
presumed to be linked to its inhibition of CNS neuronal uptake of serotonin.
Other antidepressants such as Zoloft and Paxil don't last as long in the body as Prozac.
Zoloft:
This medication is not as much of an activator and it can help with sleep .
Both Prozac and Zoloft are very easy to use.

Not FDA approved for kids but sometimes used when other interventions are not
working

Lexapro:
Lexapro works by boosting levels of serotonin, one of the chief chemical messengers in
the brain. The drug is a close chemical cousin of the antidepressant medication Celexa.
The SNRIs:

These medications are known as serotonin-norepinephrine reuptake inhibitors. They are
a new class of antidepressants targeting both serotonin and norepinephrine.
Effexor:
Effexor is an SNRI and since it increases both seratonin and norepinephrine it can give
users more of an energizing effect
It is typically prescribed for the treatment of major depression and anxiety disorders.
Effexor has a relatively short half-life
Cymbalta: Cymbalta was the first antidepressant to hit the market since the FDA began studying whether antidepressants can increase the risk of suicide, particularly when used by adolescents. There are some promising results with certain studies and it has similar positive effects as Effexor. However, there is still a need for further studies to determine its overall effectiveness.

Source: http://www.davidpdiana.com/wp-content/uploads/2008/10/med_ref_guide_children1.pdf