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Guide for Use and Monitoring of Psychotropic Medications in Children and Adolescents

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Guide for Use and Monitoring of Psychotropic Medications in Children and Adolescents Guide for Use and Monitoring of Psychotropic Medications In Children and Adolescents This document was developed by Community Care of North Carolina with the assistance of Fostering Health NC’s Medication Management Workgroup. The information contained in this guide is not intended to substitute or act as medical advice. If you have any questions about a medication prescribed to a child or adolescent in your care, contact the prescriber or a licensed medical professional. www.ncpeds.org/fosteringhealthnc 1 | P a g e Guide for Use and Monitoring of Psychotropic Medications In Children and Adolescents (Original 3.22.17 – revised 5.22.19) Definition of Psychotropic Medication: Medication used in the treatment of mental illnesses and capable of affecting the mind, emotions, and behavior. Use of this Information: The tables below offer information for child welfare workers, care managers and foster/resource parents to use when they want to learn more about a psychotropic medication. Specific information is outlined including therapeutic class, brand and generic names, FDA approved uses, common evidence-based uses, potential side effects, and medication-specific safety/effectiveness monitoring necessary when prescribed to a child or adolescent. Because few medications have been FDA approved for use in children 5 years of age and under, there is a column in the table that lists the FDA approved status and age ranges for the approved uses of each medication. This guide also provides a color-coded quick reference guide for each medication (Appendix A), questions that a foster/resource parent should ask a prescriber (Appendix B), and a glossary of terms (Appendix C). Information provided in this document is based on “Psychotropic Medication Utilization Parameters for Children and Youth in Foster Care”, 5th Version- Texas Dept. of FPS; Lexicomp. Table of Contents: Page(s): ADHD Medications 3 Depression & Anxiety Medications 4-5 Second Generation Antipsychotic Medications 6-7 Mood Stabilizer Medications 8-10 Sleep Medications 11-12 Appendix A: Color-Coded Psychotropic Medications 13-14 Appendix B: Questions to Ask the Prescriber 15 Appendix C: Glossary of Terms 16-17 2 | P a g e Guide for Use and Monitoring of Psychotropic Medications In Children and Adolescents (Original 3.22.17 – revised 5.22.19) ADHD Medications (1) Stimulants FDA Approval Other Common Generic Name Brand Names Potential Side Effects Monitoring Age/Indication Uses in Children Amphetamine Mixed Adderall, Adderall XR 3 and older; None • Increased blood pressure • Height Salts 6 and older (XR) • Increased heart rate • Weight Dextroamphetamine Dexedrine, Zenzedi 3 and older • Tics (abnormal movement • Heart rate Lisdexamfetamine Vyvanse 6 and older most often in the face) • Blood pressure Methylphenidate Ritalin, Ritalin SR, 6 and older • Weight loss Ritalin LA, Methylin, • Loss of appetite Methylin ER, • Sleep disturbance Metadate ER, • Irritability/anxiety Metadate CD, Quillivant XR, Concerta, Aptensio XR Dexmethylphenidate Focalin, Focalin XR 6 and older Other ADHD Medications FDA Approval Other Common Generic Name Brand Names Potential Side Effects Monitoring Age/Indication Uses in Children Atomoxetine Strattera 6 and older None • Increased blood pressure • Height • Increased heart rate • Weight • Sleep disturbance • Heart rate • Stomach discomfort • Blood pressure • Dizziness Clonidine Catapres, Kapvay IR form not FDA None • Low blood pressure • Heart rate approved for children; • Decreased heart rate • Blood pressure ER form ages 6-17 • Feeling faint or dizzy Guanfacine Tenex, Intuniv 6 and older None • Feeling tired 3 | P a g e Guide for Use and Monitoring of Psychotropic Medications In Children and Adolescents (Original 3.22.17 – revised 5.22.19) Depression & Anxiety Medications (2) SSRIs (Selective Serotonin Reuptake Inhibitors) FDA Approval Other Common Generic Name Brand Names Potential Side Effects Monitoring Age/Indication Uses in Children Citalopram* Celexa 18 and older Obsessive • Suicidal thoughts or behavior • Suicidal thoughts or Escitalopram Lexapro 12-17 for depression Compulsive Disorder • Weight gain behavior Fluoxetine Prozac 8 and older for (OCD) • Headache • Height depression • Stomach discomfort • Weight Paroxetine* Paxil 18 and older • Sleep disturbance Fluvoxamine Luvox 8 and older for OCD • Flu-like symptoms if stopped Sertraline Zoloft 6 and older for OCD too quickly Vilazodone* Vibryd 18 and older • Abnormal generalized bleeding risk *not approved for children and adolescents SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) FDA Approval Other Common Generic Name Brand Names Potential Side Effects Monitoring Age/Indication Uses in Children Venlafaxine* Effexor, Effexor XR 18 and older Obsessive • Suicidal thoughts or behavior • Suicidal thoughts or Compulsive Disorder • Weight gain behavior Duloxetine Cymbalta 7 and older for (OCD) • Headache • Height Generalized Anxiety • Seizures • Weight Disorder • Hyponatremia/low blood • Blood pressure during initial Desvenlafaxine* Pristiq 18 and older sodium levels dose adjustment and • Hepatic toxicity/liver periodically thereafter Clomipramine Anafranil 10 and older for OCD damage • EKG for Anafranil • Skin reactions Levmilnacipram* Fetzima 18 and older • Stomach discomfort *not approved for children and adolescents • Sleep disturbance • Flu-like symptoms if stopped too quickly • Elevated blood pressure/pulse • Abnormal bleeding risk 4 | P a g e Guide for Use and Monitoring of Psychotropic Medications In Children and Adolescents (Original 3.22.17 – revised 5.22.19) Depression & Anxiety Medications (2) Other Depression & Anxiety Medications FDA Approval Other Common Generic Name Brand Names Potential Side Effects Monitoring Age/Indication Uses in Children Mirtazapine* Remeron 18 and older None • Suicidal thoughts or behavior • Suicidal thoughts or • Abnormal bleeding risk behavior Vortioxetine* Brintellix/Trintellix 18 and older None • Weight gain • Height • Headache • Weight • Hyponatremia • Blood pressure-during • Stomach discomfort titration and periodically • Sleep disturbance • Flu-like symptoms if stopped too quickly • Dizziness • Liver toxicity, seizures, and white blood cell decrease risk with mirtazapine Bupropion* Wellbutrin, 18 and older ADHD • Increased blood pressure, • Blood pressure and pulse- Wellbutrin XL/SR elevated pulse during titration and • Seizure risk periodically • Discontinuation Syndrome if • Suicidal thoughts or stopped abruptly behavior • Appetite suppression • Seizure risk • Suicidal thoughts or behavior • Weight *not approved for children and adolescents 5 | P a g e Guide for Use and Monitoring of Psychotropic Medications In Children and Adolescents (Original 3.22.17 – revised 5.22.19) Second Generation Antipsychotic Medications (3) FDA Approval Other Common Generic Name Brand Names Potential Side Effects Monitoring Age/Indication Uses in Children Aripiprazole Abilify Approved for children For all second • Acute Extrapyramidal • Fasting plasma glucose or 10 and older for bipolar generation symptoms hemoglobin A1c and lipids disorder, manic or antipsychotics: • Tardive dyskinesia at baseline, 3 months, then mixed episodes. Irritability and • Neuroleptic malignant every 6 months Approved for Aggression in syndrome • CBC- baseline and adolescents 13 to 17 - Disruptive Mood • Hyperglycemia, diabetes periodically for schizophrenia and Dysregulation disorder, mellitus • Blood pressure each visit bipolar disorder. Oppositional Defiant • Elevated prolactin, • Pulse each visit Approved for 6 to 17 Disorder, Conduct gynecomastia, amenorrhea • Weight/height/BMI at each year olds for irritability Disorders. Depression • Weight gain visit associated with Autism with psychotic • Dyslipidemia • Waist circumference Spectrum Disorder features. • CBC abnormalities • EPS evaluation baseline Quetiapine Seroquel, Seroquel XR Approved for Approved for bipolar • Lowered seizure threshold and as needed adolescents 13 and mania (10-17 years); • Dysphagia • Tardive dyskinesia older for schizophrenia. schizophrenia (13-17 • Hyperthermia/lowered evaluation every 3 months Approved for young years) heat tolerance • Clozapine-requires REMS adults 18 and older for • Cognitive impairment bipolar disorder. (confusion and/or inability Approved for 10 to 17 to focus that differs from year-olds for manic and baseline) mixed episodes of bipolar disorder Olanzapine Zyprexa 18 and older- Approved for bipolar schizophrenia; 13 to mania or mixed 17- second line episodes and treatment for manic or schizophrenia (13-17 mixed episodes of years) bipolar disorder Risperidone Risperdal 13 and older- Approved for schizophrenia; 10 and schizophrenia (13-17 older- bipolar mania years); bipolar mania and mixed episodes; 5 or mixed episodes (10- to 16- irritability 17 years); irritability associated with autism associated with autism spectrum disorder (5- 16 years) 6 | P a g e Guide for Use and Monitoring of Psychotropic Medications In Children and Adolescents (Original 3.22.17 – revised 5.22.19) Second Generation Antipsychotic Medications (3) FDA Approval Other Common Generic Name Brand Names Potential Side Effects Monitoring Age/Indication Uses in Children Clozapine* Clozaril, FazaClo, 18 and older Schizophrenia Versacloz Same as previous page Same as previous page Asenapine Saphris Approved for acute Schizophrenia treatment of bipolar mania and mixed episodes (10-17 years) Iloperidone* Fanapt 18 and older None Paliperidone Invega Approved for treatment of schizophrenia (12-17 years) Ziprasidone* Geodon 18 and
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