EPSDT Care for Kids Newsletter

Fall 2010 ADHD Medication Chart - Non-stimulants
Drug	Dosage form	Side effects and precautions	Dose range and comments	Doses/ Day
Catapres (clonidine) a₂ adrenergic agonist	Tablets 0.1, 0.2, 0.3 mg	Dizziness, sedation, confusion, nausea, vomiting, constipation, local reaction (to patch), hypotension, weakness, somnolence, impotence, pancreatitis, agranulocytosis, electrolyte imbalance. Avoid abrupt withdrawal (to avoid rebound hypertension). Contraindications: 1) allergy 2) conduction disturbances 3) chronic renal failure 4) severe coronary insufficiency 5) cerebrovascular disease (Not approved by the FDA for ADHD.)	Start with a dose of 0.25-0.5 mg/day in the evening. Titrate in 0.05 mg increments no faster than every seven days. Given in divided doses 2-4 times per day. Daily dose range 0.1-0.3 mgs/day. Do not skip doses (to avoid rebound hypertension.) Need to taper off. May not see effects for 4-6 weeks. Helpful for sleep disturbance, tics, modulating mood, and ADHD symptoms.	1-4
Drug	Dosage form	Side effects and precautions	Dose range and comments	Doses/ Day
Intuniv (long-acting guanfacine) a₂adrenergic agonist	Tablets 1, 2, 3, and 4 mg	Orthostatic hypotension, palpitations, bradycardia, depression, dizziness, fatigue, headache, somnolence, anorexia, constipation, acid indigestion, liver toxicity Avoid with significant liver, kidney, or cerebrovascular disease. Avoid abrupt withdrawal (to avoid rebound hypertension).	Start with 1 mg/day in the evening and increase by 1 mg every 7 days as indicated. Once a day dosing. Daily dose range 1-4 mg/day with maximum daily dose of 4 mg. Don't skip doses (to avoid rebound hypertension). Need to taper off. Helpful for sleep disturbance, tics, modulating mood, and ADHD symptoms.	1
Drug	Dosage form	Side effects and precautions	Dose range and comments	Doses/ day
Tenex (guanfacine) a₂adrenergic agonist	Tablets 1 mg, 2 mg	Orthostatic hypotension, palpitations, bradycardia, depression, dizziness, fatigue, headache, somnolence, anorexia, constipation, acid indigestion, liver toxicity Avoid with significant liver, kidney, or cerebrovascular disease. Avoid abrupt withdrawal (to avoid rebound hypertension).	Start with 0.5 mg in the evening and increase by 0.5 mg every 7 days as indicated, to no more than 1 mg/kg with a maximum daily dose of 4 mg. Divided into BID to TID dosing. Don't skip doses (to avoid rebound hypertension). Need to taper off. Helpful for sleep disturbance, tics, modulating mood, and ADHD symptoms.	1-4
Drug	Dosage form	Side effects and precautions	Dose range and comments	Doses/ Day
Strattera (atomexetine) Selective nor-epinephrine reuptake inhibitor	Capsules 10, 18, 25, 40, 60, 80, 100 mg	Decreased appetite, weight loss, nausea, vomiting (take with food), sedation, mood swings, lightheadedness Use cautiously in patients with hypertension, hypotension, hypotension, tachycardia, cardiovascular, or cerebrovascular disease (monitor vitals), hepatic or renal insufficiencies (can increase blood pressure and heart rate), and urinary retention. Use cautiously in patients with poor metabolizer CYP2D6 phenotype or aggressive behaviors. Do not use if currently using, or have used within 2 weeks, any MAOI. Do not use with narrow angle glaucoma. Not indicated in patients with a seizure disorders or with current or previous diagnoses of bulimia or anorexia. May worsen tics. Black Box warning: Increased risk of suicidal ideation in short-term studies in children or adolescents with ADHD. Monitor patients closely for suicidality (suicidal thinking and behavior), clinical worsening, or unusual changes in behavior.	Initial dose 0.5 mg/kg given as a single dose in AM. Increase up to 1.2 mg/kg after 4-7 days. Targeted clinical dose is about 1.2 mg/kg/day with a maximum daily dose of 100 mg. Given in AM and must be used each day. If higher doses are needed, can be divided into AM and PM doses. When switching from stimulant to Strattera (atomoxetine), continue the stimulant for at least 4 weeks after starting Strattera.	1-2
Disclaimer: This chart is not intended to serve as a totally comprehensive resource. Please utilize Physicians Desk Reference for complete information. ADHD Medication Chart - Stimulants Return to Fall 2010 Index