Medications | Dose | Comments |
---|---|---|
Methylphenidate Immediate-release (RITALIN) | Child 4–5 years: Starting dose: 2.5 mg twice daily, PO, increased in steps of 2.5 mg daily if required, at weekly intervals Maximum dose: 1.4 mg/kg daily in 2–3 divided doses Child 6–17 years: Starting dose: 5 mg 1–2 times a day, PO, increased in steps of 5–10 mg daily if required, at weekly intervals increased if necessary up to 60 mg daily in 2–3 divided doses, increased if necessary up to 2.1 mg/kg daily in 2–3 divided doses Maximum dose: 60 mg daily in 2–3 doses, higher dose (up to a maximum of 90 mg daily) under the direction of a specialist | Cautions: Agitation, anxiety, drug dependence, epilepsy (discontinue if increased seizure frequency), family history of Tourette syndrome, susceptibility to angle-closure glaucoma, and tics Contraindications: Anorexia nervosa, arrhythmia, cardiomyopathy, cardiovascular disease, cerebrovascular disorders, heart failure, hyperthyroidism, phaeochromocytoma, psychosis, severe depression, severe hypertension, structural cardiac abnormalities, suicidal ideation, uncontrolled bipolar disorde, and vasculitis Common side effects: Alopecia, anxiety, decreased appetite, arrhythmias. Arthralgia, Abnormal behaviour, cough, depression, diarrhoea, dizziness, drowsiness, dry mouth, fever, gastrointestinal discomfort, growth retardation, headaches, hypertension, laryngeal pain, altered mood, movement disorders, nasopharyngitis, nausea, palpitations, sleep disorders, vomiting, and decreased weight |
Modified-release CONCERTA ® XL | Starting dose: 18 mg once daily to be taken in the morning, increased in steps of 18 mg every week adjusted according to response increased if necessary up to 2.1 mg/kg daily Maximum dose: 54 mg once daily Dose equivalence and conversion Total daily dose of 15 mg of standard-release formulation is considered equivalent to Concerta ® XL 18 mg once daily | |
Lisdexamfetamine | Child 6–17 years: Starting dose: 30 mg once daily, PO, alternatively initially 20 mg once daily, increased in steps of 10–20 mg every week if required, dose to be taken in the morning, discontinue if response insufficient after 1 month; Maximum dose: 70 mg per day | Cautions: Bipolar disorder, history of cardiovascular disease, history of substance abuse, may lower seizure threshold (discontinue if seizures occur), psychotic disorders, susceptibility to angle-closure glaucoma, tics, and Tourette syndrome Contraindications: Advanced arteriosclerosis, agitated states, hyperthyroidism, moderate to severe hypertension, and symptomatic cardiovascular disease Common side effects: Upper abdominal pain, anxiety, decreased appetite, abnormal behaviour, constipation, depression, diarrhoea, dizziness, drowsiness, dry mouth, dyspnoea, fatigue, feeling jittery, fever, headache, insomnia, mood altered, nausea, palpitations, psychiatric disorders, skin reactions, tachycardia, tremor, vomiting, and decreased weight |
Dexamfetamine | Child 6–17 years: Starting dose: 2.5 mg 2–3 times a day,PO, increased in steps of 5 mg once weekly if required Maximum dose: 1 mg/kg daily, up to 20 mg daily (40 mg daily has been required in some children). maintenance dose to be given in 2–4 divided doses | Cautions: Anorexia, bipolar disorder, history of epilepsy (discontinue if seizures occur), mild hypertension, psychosis, susceptibility to angle-closure glaucoma, tics, and Tourette syndrome Contraindications: Agitated states, cardiovascular disease, history of drug abuse, hyperexcitability, hyperthyroidism, moderate hypertension, severe hypertension, and structural cardiac abnormalities Common side effects: Abdominal pain, anxiety, decreased appetite, arrhythmias, arthralgia, abnormal behaviour, depression, dry mouth, headache, altered mood, movement disorders, muscle cramps, nausea, palpitations, poor weight gain, sleep disorders, vertigo, vomiting, and decreased weight |
Atomoxetine | Child 6–17 years (body-weight up to 70 kg): Starting dose: 0.5 mg/kg daily, PO, for 7 days, dose is increased according to response; maintenance 1.2 mg/kg daily, total daily dose may be given either as a single dose in the morning or in 2 divided doses with last dose no later than early evening, Maximum dose: 1.8 mg/kg/day or 120 mg per day (high daily doses to be given under the direction of a specialist) Child 6–17 years (body-weight 70 kg and above): Starting dose: 40 mg daily for 7 days, dose is increased according to response; maintenance 80 mg daily, total daily dose may be given either as a single dose in the morning or in 2 divided doses with last dose no later than early evening, high daily doses to be given under the direction of a specialist Maximum dose: 120 mg per day | Cautions: Aggressive behaviour, cardiovascular disease, cerebrovascular disease, emotional lability, history of seizures, hostility, hypertension, mania, psychosis, QT interval prolongation, structural cardiac abnormalities, susceptibility to angle-closure glaucoma and tachycardia Contraindications Phaeochromocytoma, severe cardiovascular disease. Severe cerebrovascular disease Common side effects: Anxiety, decreased appetite, asthenia, chest pain, constipation, depression, dizziness, drowsiness, gastrointestinal discomfort, headaches, insomnia, altered mood, mydriasis, nausea, skin reactions, tic, vomiting and decreased weight |
Guanfacine | Child 6–12 years (body-weight 25 kg and above): Starting dose: 1 mg once daily; PO, adjusted in steps of 1 mg every week if necessary and if tolerated; maintenance 0.05–0.12 mg/kg once daily Maximum dose: 4 mg per day Child 13–17 (body weight 41.5–49.4 kg): maximum dose 5 mg, Child 13–17 (body weight 49.5–58.4 kg): maximum dose 6 mg Child 13–17 (body weight 58.4 kg and above): maximum dose 7 mg | Cautions: Bradycardia (risk of torsade de pointes), heart block (risk of torsade de pointes), history of cardiovascular disease, history of QT-interval prolongation, and hypokalaemia (risk of torsade de pointes) Common side effects: Anxiety, decreased appetite, arrhythmias, asthenia, constipation, depression, diarrhoea, dizziness, drowsiness, dry mouth, gastrointestinal discomfort, headache, hypotension, mood altered, nausea, skin reactions, sleep disorders, urinary disorders, vomiting, and increased weight |
Clonidine | Child ≥ 6 year and adolescent): Immediate-release product (PO): Starting dose: 0.05 mg  at bed time; if needed, increase by 0.05 mg every 3–7 days Maximum dose: 0.4 mg/24 h in 3–4 divided doses Extended-release product (PO): Starting dose: 0.1 mg  at bed time; if needed increase by 0.1 mg every 7 days BID Maximum dose: 0.4 mg/24 h | Cautions: Cerebrovascular disease, constipation, heart failure, history of depression, mild to moderate bradyarrhythmia, polyneuropathy, Raynaud’s syndrome or other occlusive peripheral vascular disease, sleep disturbance, rages or tics Contraindications Severe bradyarrhythmia secondary to second—or third-degree AV block or sick sinus syndrome Common side effects: Constipation, depression, dizziness, dry mouth, fatigue, headache, nausea, postural hypotension, salivary gland pain, sedation, sexual dysfunction, sleep disorders, and vomiting |