1: ADHD

Scientific name Trade name Dose Comments

Methylphenidate Immediate Start 5-10 mg/d  Monitor:
release: Titrated 5-10 mg/ week -BP
Ritalin Max.: 60 mg/d -Pulse
Onset: in 20-60 m. -Height & Wt
STIMULANTS

Duration: 2 – 4 hours -Insomnia

-Appetite
-Mood
-Tics development
Sustained Start 18mg/ d  Discontinue If no benefits seen
release: Titrated up to 54 mg/ d in 1 month
Concerta Onset: in 30 m. – 2 hours
Duration: 12 hours
Dexamphetamine Dexedrine

Atomoxetine Sterratera < 70 kg  1st line alternative after

Atomox Apex Start: 0.5 mg/ kg/ d Stimulants
10, 25, 40, 80 Maintenance:  or to whom their medication
mg Cap Increase in 7-10 days to 1.2 cant be administered during
mg/ kg/ d the day
Max.: 1.8 mg/ kg/ d  when TICS become problematic
>70 kg  when shifting, Continue
Start: 40 mg/ d stimulant for 1st 4 weeks.
Maintenance: 80  Monitor: pulse, BP, height,
weight, LFTs
3rd Line:
Clonidine
TCA

‫وحدة طب نفسي األطفال‬ ‫مستشفى العباسية للطب النفسي‬

2. Antidepressant uses: Depression
Anxiety spectrum and OCD
Scientific name Trade name Dose Side effects Comments
Anafranil , 1-3 mg/kg /day  Wt change ↑  OCD ( approved)
Clomipramine Anapramine Once daily at bed time  Not effective in
 Sedation
(TCA) 25 mg tab  ↑appetite Dep.
75 mg tab (may↓)  On TTT ECG
 Headache required
 Blurred vision  Not with MAOIs
 Dry mouth
 Constipation
 Cardiotoxicity

Sertral start by 25mg  GIT trouble  should monitor

Sertraline 50 mg tab *6-12years:25-50 mg  Headache suicidal thoughts
(SSRIs)  Not with MAOIs
*>13 & adult: 50-200  ↓appetite
*Once at Morning (may↑)  OCD(approved)
 Rash
Fluoxetine start by 10 mg  As Serteraline +
Fluoxetine 20 mg cap 20-60 mg/day
 Vivid dreams
 1st choice in Dep.
 Nightmares
(SSRIs) Once at Morning  Sweating

Tritico 1.5-2 mg/kg/day tds  GIT upset N.B:

Trazodone 50 mg tab (100-150)  Sedation
(SARI) All have cardiac
 headache
 Priapism problems

(rare but serious)

1.
‫وحدة طب نفسي األطفال‬ ‫مستشفى العباسية للطب النفسي‬
 3.Antiepileptic Uses: Epilepsy, Mood stabilizer
2. & Aggression (as in MR or Autism)
Scientific name Trade name Dose Side Effect Comments
Valproate 15-60 mg/kg/day  Wt gain  Monitor:
Depakine Tds  Polycystic ovary liver function,
tab 200 mg  Alopecia Albumin, PT,CBC
Dekadel Extended release  Liver toxicity at start & /6 months
syrup once/ day  Pancreatitis  Plasma level > 50
200mg/5ml mg/ml ( 80-120 )
1cm =  Not recommended
57.2mg of depak. under 10 years for
40 mg of dekadel bipolar
Carbamazepine 10-20 mg/kg/day  Wt gain  liver function, Urea,
Tegretol 2-3 divided doses  Metabolic synd. Electrolyte, CBC
200 mg tab  Agranulocytosis at start & /6 months
Syrup Start : 200 mg/d  Headache.  take with food to
Arbateg range: 400–800  Sedation avoid GIT upset
syrup 2% max. dose: 1000  higher peak level occur
 Rash
with suppression so :
1cm = 20mg use 4 times/d & start at
1tab. 200mg=10cm lower dose

Lamotrigine  Titration :
Lamictal *1-5 mg/kg  Fatigue -start 0.3 mg / kg / d
25, 50 & *once or twice /d  Somnolence -Doubled every 2
100 mg (100-400 mg)  Headache weeks 1st 2 times
Scored tab.  Rash -Then doubled every
week
 Reduced by 50% if
used with Valproate
 Doubled if used with
Tegretol
 Approved to less than
16 only as add on for
LGS & partial Seizures
 Avoid with TCAs &
MAOIs
Phenytoin 5-7 mg/kg/day  GIT upset
Epanutin Twice/d  Ataxia
Sodium 100 mg cap  Nystagmus
 Rash
 Gum hyperplasia

‫وحدة طب نفسي األطفال‬ ‫مستشفى العباسية للطب النفسي‬

 4.Antipsychotics Uses: early schizophrenia
and in MR or Autism as anti aggression.
Scientific name Trade name Dose Side Effect Comments
Chlorpromazine 0.5-1  Wt Gain  Chlorpromazine is
Promacid mg/kg/day  EPS: FDA approved in
Neurazine 3-4 doses/d -Dystonia (acute or chronic) Hyperactive child
25 and 100 Max. : -Akathesia with Conduct
mg  <5y -Psudoparkinsonism Disorder
40mg/d -Tardive dyskinesia  Dystonia: commonly
 5-12y  NMS (rare) in eye and neck
75mg/d  Hyperprolactinemia  Psudoparkinsonism:
Safinace -Galactorrhea tremor
Haloperidol 5 mg tab -Amenorrhea rigidity
(scored) 0.01-0.2 bradykinesia
Stellasil mg/kg/day in   NMS: triad of
Trifluperazine 5mg tab
Sedation
2-3 divided -hyperthermia
doses -Rigidity
-Autonomic Instability
Psychodal 0.015 – 0.05  EPS at higher dose
1mg tab mg/kg/day  Wt gain
Risperidone Rescure  Hyperprolactinemia
1 and 4mg One drop = 0.05
Apexidone mg
1mg(syrup) 1mg = 1 cm

5.Mood stabilizer Uses: Bipolar disorder.

Scientific name Trade name Dose Side Effect Comments
Pirianil 15 -60  GIT upset MONITOR:
Lithium 400 mg tab mg/ kg/ day  Abnormal EEG
(scored) 3 times/ d  Fine tremors  Plasma level
 Sedation ( 0.8-1.2 mEq /l)
 Nephrotoxcity 1 week after initiation
 Anorexia 1 week after every dose change
Nausea , then: Every 3 months
Diarrhea
 Ms. Weakness  Renal Function
 Coarse tremors At start & every 6 months
 TOXICITY
Depakine Na
Carbamazepine Discussed Previously
Novel antipsychotics

‫وحدة طب نفسي األطفال‬ ‫مستشفى العباسية للطب النفسي‬