Stimulant medication and dosage: Based on the patient's daily schedule and response to medication, Measure at baseline and periodically monitor: Height, weight, blood pressure, pulse, sleep, appetite, mood, tics, family goals, and side effects. Stimulant Medications - Immediate Release Duration of Behavioral Active Ingredient Drug Name Dosing Effecst Med sls oF * Adderall Start wih mg 1-2 mes pe day and About 46 Dextoamphotanine! | Tablets cored mg (is), 10mg | increase by Sg each werk wt good ——_| hous Levoamphetamine) (bluc), 20 mg (pink), and 30 mg control achieved. depending rin) Maxinsm Recommended Daily Dose: 40 mg_ | on dose Do not use in patients with Cardia disease Dexoanpheamine | Dexedrine Tablet Stat with Sg 1-2 ines per day Tblee 5 Tablet: $ mg (orange) andineease by Smg each week unt hous sDentrotat Tablet (cored mg | good onto achieved. Maxima (yellow) and Recommended Daily Dose: 40 mg 10 mg yellow) Mhyiphenidae = Ritalin Sart wih Sg @.5 mg for Foals) 2 ines | 3-4 hows Tables (cored), 10, and 20mg | pr day and increase by mg each week uni fethylin good contol achieved. May ned third Tablets (scored), 10,and20mg | reduced dose in the afternoon, Maximum “Focaln Recommended Daily Dose: 60 mg Tables: 2.5, 5, and 10 mg Stimulant Medications Sustained Release, continued on side 2 Duration of Behavioral Active Ingredient Drug Name Dosing Effecis* Mord sls of + Adderall XR Start 10 gin the moming and increase | $12 hours extoamphetamine! | Capsule fan be sprinkled: 10 mg by 10mg each week unl good contol s Levoamphetamie) (bie), 20 mg orangsiorange), | achieved and 30mg (stra rang) Maximum Recommended Dlly Dose: 40 mg Do mot ure in patents with Cardiac disease Dextoanphvtamine _ » Dexedne Spans Start aS mg the moring and increase by | ETO ows Spnsule an be sprinted, 10, | S mg cach week uti good conta i achieved, and 15 mg (orange/black) Maximum Recommended Daily Dose: 45 mg Masylphenidae = Conceta Start ar 18 mg each moring and increase by | E12 owe Capsule (roncrashable): 18,27, 36, | 18 mgeach week uti good conto i achieve and 54mg Maxim Recommended Daily Dose 72mg = Rian SR Starts 20 mgin the moming and increase | 4-8 hous Tablet: 20 mg SR (white) by 20 mg each week until good control is + Ritalin LA achieved, May need second dos or reqslr apne (can be printed): 20,30, | methylphenidate dose inthe afternoon and 40 me Maxim Recommended Daily Dose 60 me SS GSR ay WE RT Note: Drugs sted on this handout donot appesrin any order of nportanc, The appearance ofthe names Amuiesn Copyright ©2002 American Academy of Petites and Academy of Pediatrie and National Intitive for Ciren’s Haltheare Quality doesnot imply endorsement of tay Nationa nitive for ‘Children's Healthcare Quaiy product or service. The recommendations in this publication do ot indcatean exclusive course of telment of serveas a standard ‘of medical are. Varatons, taking ino account gavidul circumstances, maybe appropri American Academy of Pediatrics e NICHQ: DEDICATED TO THE HEALTH OF ALL CHILDREN" Mon etre ir tearyStimulant Medications Sustained Release, continued ‘Active Ingredient Drug Name Dosing Duration of Behavioral Effects Wicigienidte ont) | oveedats ER Stat at 1Omg.cach momingand increase | — 4-8 hours Tablet: 10 and 20 mg extended release | by 10mg each week unl ood contol is “Methyl ER achieved. May need second dose or real Tablet: 10 and 20 mg extended me thylphenidate dose in the afternoon. releases, Maximum Recommended Daly Dose: come “sada CD Start at Tong cach momaingand nares] Sours Capsule: 10,20, and 30 mg ex by 10mg mg each week util good contra release (an be sprinkled) i achieved Maximum Recommended Daily Dose come Contraindications and Side Effects Active Ingredient Contraindications (Stimulants can be used in children with epilepsy.) Mixed salls of amphetamine ‘MAO Inhibitors within 14 days Glaucoma, Cardiovascular disease, Hypertayroidism Moderate to severe hypertension Dexiroamphetamine MAO Inhibitors within 14 days Glaucoma Methylphenidate MAO Inhibitors within 14 days Glaucoma Preexisting severe gaslrointestinal narrowing Caution should be used when prescribing concomitantly with anticoagulants, anticonvulsants, phenylbutazone, and tricyclic antidepressants ‘Common Side Effects: + Decreased appetite + Sleep problems + Transient headache + Transient stomachache + Behavioral rebound Infrequent Side Effects: + Weight loss + Increased heatt rate, blood pressure + Dizziness + Growth suppression * Hallucinations/mania + Exacerbation of ties and Tourette syndrome (rare) Possible Strategies for Common Side Effects: (one stimulant is not working or produces too many adverse side effects, ry ‘nother stimulant before using a different class of medications.) Decreased Appetite Behavioral Rebound lritability/Dysphoria * Dose after meals + Try sustained-release stimulant + Deerease dose + Frequent snacks medication + Try another stimulant medication + Drug holidays + Add reduced dose in late afternoon * Consider coexisting conditions, especially depression Sleep Problems Exacerbation of Ties (rare) Psychosis/Euphoria/Mania/Severe + Bedtime routine + Observe Depression + Reduce or eliminate afternoon dose + Reduce dose + Stop treatment with stimulants * Move dosing regimen to earlier time + Try another stimulant or class of + Referral to mental health specialist» Restrict or climinate caffeine medications Non Stimulant Medications Rative Ingredient Drug Name Dosing ‘Atomoxetine HCL Saartera ‘Stari as a single daily dose, based on weight, 0Smpky day Capsule: 10mg, 18mg, 25mg, for the first week then inerease up to a max 1.4 mgikgiday 40 mg, 60mg all given in 1 daily dose. ‘se ae ena, a GoraTon may vary with vial chi Note Drags Ted his badout do wot apear i any onder oF mmparance. The appearance af ‘the names American Copyright ©2002 American Academy of Podatnce and Academy of Pediatrics and National Inkave fr Chile's Healinare Quality docs ‘ot imply endorsement of ay National native for Childen’s Healthcare Quality produto service. The recommendations in ths publication do not nice a exclusive cours of tettmeat or seve asa stated of medical cre, Vailions, ting inl socout individual cumstances muy be appropriate American Academy of Pediatrics , NICHQ: DEDICATED 70 THE HEALTH OF ALL CHILDREN" eae oe Bae Oa