BNF for Children 2011-2012

188 4.4 CNS stimulants and other drugs for ADHD BNFC 2011–20124–7 days according to response (total daily dosesabove 50 mg in 2 divided doses); max. 100 mgtwice dailyNote If no improvement in obsessive-compulsive disorderwithin 10 weeks, treatment should be reconsidered4.3.4 Other antidepressantdrugsClassification not used in BNF for Children.4 Central nervous systemFluvoxamine (Non-proprietary) ATablets, fluvoxamine maleate 50 mg, net price 60-tabpack = £10.81; 100 mg, 30-tab pack = £11.67. Counselling,drivingFaverin c (Abbott Healthcare) ATablets, f/c, scored, fluvoxamine maleate 50 mg, netprice 60-tab pack = £17.10; 100 mg, 30-tab pack =£17.10. Counselling, drivingSERTRALINECautions see notes aboveContra-indications see notes aboveHepatic impairment reduce dose or increase doseinterval in mild or moderate impairment; avoid insevere impairmentRenal impairment use with cautionPregnancy see notes aboveBreast-feeding not known to be harmful but considerdiscontinuing breast-feedingSide-effects see notes above; pancreatitis, hepatitis,jaundice, liver failure, stomatitis, palpitation, hypertension,hypercholesterolaemia, tachycardia, posturalhypotension, bronchospasm, amnesia, paraesthesia,aggression, hypoglycaemia, hypothyroidism, hyperprolactinaemia,urinary incontinence, menstrual irregularities,leucopenia, and tinnitus also reportedLicensed use not licensed for use in children fordepressionIndication and doseObsessive-compulsive disorder. By mouthChild 6–12 years initially 25 mg daily increased to50 mg daily after 1 week, further increased ifnecessary in steps of 50 mg at intervals of at least 1week; max. 200 mg dailyChild 12–18 years initially 50 mg daily increasedif necessary in steps of 50 mg over several weeks;max. 200 mg dailyMajor depression (but see Depressive Illness inChildren and Adolescents, above). By mouthChild 12–18 years initially 50 mg once dailyincreased if necessary in steps of 50 mg daily atintervals of at least a week; max. 200 mg once dailySertraline (Non-proprietary) ATablets, sertraline (as hydrochloride) 50 mg, net price28-tab pack = £1.15; 100 mg, 28-tab pack = £1.53.Counselling, drivingLustral c (Pfizer) ATablets, both f/c, sertraline (as hydrochloride) 50 mg(scored), net price 28-tab pack = £17.82; 100 mg, 28-tab pack = £29.16. Counselling, driving4.4 CNS stimulants and otherdrugs for attention deficithyperactivity disorderCNS stimulants should be prescribed for children withsevere and persistent symptoms of attention deficithyperactivity disorder (ADHD), when the diagnosishas been confirmed by a specialist; children with moderatesymptoms of ADHD can be treated with CNSstimulants when psychological interventions havebeen unsuccessful or are unavailable. Prescribing ofCNS stimulants may be continued by general practitionersunder a shared-care arrangement. Treatment ofADHD often needs to be continued into adolescence,and may need to be continued into adulthood.Drug treatment of ADHD should be part of a comprehensivetreatment programme. The choice of medicationshould take into consideration co-morbid conditions(such as tic disorders, Tourette syndrome, andepilepsy), the adverse effect profile, potential for drugmisuse, and preferences of the child and carers. Methylphenidateand atomoxetine are used for the managementof ADHD; dexamfetamine is an alternative inchildren who do not respond to these drugs. Beforeinitiation of drug therapy, and every 6 months thereafter,pulse, blood pressure, weight, and height should bemeasured.The need to continue drug treatment for ADHD shouldbe reviewed at least annually. This may involve suspendingtreatment.A tricyclic antidepressant such as imipramine (section4.3.1) is sometimes used in the treatment of ADHD; itshould not be prescribed concomitantly with a CNSstimulant.Modafinil is used for the treatment of daytime sleepinessassociated with narcolepsy; dependence with longtermuse cannot be excluded and it should therefore beused with caution.Dexamfetamine and methylphenidate [both unlicensed]are also used to treat narcolepsy.ATOMOXETINECautions see notes above; also cardiovascular diseaseincluding hypertension and tachycardia; structuralcardiac abnormalities; QT-interval prolongation(avoid concomitant use of drugs that prolong QTinterval); psychosis or mania; history of seizures;aggressive behaviour, hostility, or emotional lability;susceptibility to angle-closure glaucoma; interactions:Appendix 1 (atomoxetine)Hepatic disorders Following rare reports of hepatic disorders,children and carers should be advised of the risk and betold how to recognise symptoms; prompt medical attention