A Medication Guide For Fragile X by Michael R. Tranfaglia MD Version 5 - March 2009 Copyright, Michael R. Tranfaglia MD All Rights Reserved About this Guide This guide is not a medical textbook and cannot take the place of a qualified physician. It is intended to serve as background information to help parents, caretakers and others to communicate with their physicians regarding medications. The medications described in this guide are to be used only under the supervision of a qualified physician; almost all are available only by prescription. Additional copies of this guide can be ordered from FRAXA Research Foundation. About the Author Dr. Michael Tranfaglia is a psychiatrist and psychopharmacologist in private practice in Newburyport, Massachusetts. Dr. Tranfaglia serves as a consulting psychiatrst for nursing homes and group homes in the greater Boston area and conducts continuing medical education seminars for physicians. He is also Medical Director and a founder of FRAXA Research Foundation. He received his B.A. in Biology from Harvard University in 1982 and his M.D. From the University of North Carolina at Chapel Hill in 1987. Dr. Tranfaglia and his wife, Katie Clapp, have a son, Andy, who has Fragile X. About FRAXA Research Foundation FRAXA Research Foundation is a national nonprofit organization which supports medical research aimed at finding a treatment or a cure for Fragile X syndrome. FRAXA was founded in 1994 by Dr. Michael Tranfaglia, Katie Clapp, and Kathy May. FRAXA funds grants and fellowships for Fragile X research, publishes a newsletter and other informational materials, and organizes events around the country to raise funds and awareness. For more information please contact: Michael Tranfaglia MD Medical Director FRAXA Research Foundation www.fraxa.org 2 A Medication Guide For Fragile X .................................................................................... 1 Yesterday, today, and tomorrow ......................................................................................... 5 Trends in Psychiatry ........................................................................................................... 7 Major Tranquilizers: The Original Fad ............................................................................ 7 Newer Drugs Worth Noting: ............................................................................................. 11 Minocycline ....................................................................................................................... 11 Provigil (modafinil) ........................................................................................................... 13 Trileptal (oxcarbazepine) .................................................................................................. 16 Newer Drugs Not Worth Noting ....................................................................................... 18 Geodon (ziprasidone) ........................................................................................................ 18 Lamictal (lamotrigine) ...................................................................................................... 18 Neurontin (gabapentin) .................................................................................................... 19 Pristiq (desvenlafaxine) .................................................................................................... 21 Available Without a Prescription ..................................................................................... 23 L-acetyl carnitine (or acetyl-L-carnitine, ALCAR) .......................................................... 23 Taurine .............................................................................................................................. 25 Vitamin E ........................................................................................................................... 27 Introduction ....................................................................................................................... 31 Who Should Be Treated? .................................................................................................. 32 Who Should Treat ? .......................................................................................................... 34 Target Symptoms ............................................................................................................... 35 Attention Deficit and Hyperactivity .................................................................................. 35 Attention Deficit ................................................................................................................ 36 Hyperactivity/Hyperkinesis ............................................................................................... 38 Anxiety ............................................................................................................................... 40 Irritability........................................................................................................................... 43 Mania ................................................................................................................................. 44 Obsessive-Compulsive Behavior ....................................................................................... 46 Insomnia ............................................................................................................................ 52 Planning A Pharmacologic Strategy ................................................................................ 54 Augmentation .................................................................................................................... 58 3 Medication Reference Section .......................................................................................... 60 Stimulants .......................................................................................................................... 66 methylphenidate (Ritalin) ................................................................................................. 69 dextroamphetamine (Dexedrine) ...................................................................................... 72 pemoline (Cylert) ............................................................................................................... 73 atomoxetine (Strattera) ..................................................................................................... 75 folic acid ............................................................................................................................ 77 Antidepressants ................................................................................................................. 80 fluoxetine (Prozac) ............................................................................................................ 84 citalopram (Celexa, Lexapro) ........................................................................................... 87 sertraline (Zoloft) .............................................................................................................. 89 paroxetine (Paxil) .............................................................................................................. 92 fluvoxamine (Luvox) ......................................................................................................... 94 venlafaxine (Effexor) ........................................................................................................ 98 trazodone (Desyrel) ......................................................................................................... 100 nefazodone (Serzone) ...................................................................................................... 102 bupropion (Wellbutrin) ................................................................................................... 104 clomipramine (Anafranil) ............................................................................................... 106 imipramine (Tofranil) ..................................................................................................... 108 desipramine (Norpramin) ............................................................................................... 110 nortriptyline (Pamelor) ................................................................................................... 112 buspirone (BuSpar) ......................................................................................................... 114 Sympatholytics ................................................................................................................. 118 clonidine (oral formulation; Catapres) .......................................................................... 119 clonidine patch (Catapres Transdermal Therapeutic System) ...................................... 122 guanfacine (Tenex) ......................................................................................................... 126 propranolol (Inderal) ...................................................................................................... 129 Mood Stabilizers .............................................................................................................. 131 lithium (Eskalith, Lithobid, Lithonate) ......................................................................... 134 carbamazepine (Tegretol) ..............................................................................................