This appendix provides more information about medications that may be prescribed to treat specific symptoms associated with autistic spectrum disorders. Being listed in this appendix does not mean that a particular medication is recommended for these disorders, but it's important to know as much as possible about drugs you may hear about or be prescribed.

Only commonly reported side effects and certain rare but especially dangerous side effects are listed. Less common and rare side effects may be associated with any medication, and you may experience side effects that no one else has ever had. If you have unusual symptoms after taking medicine, or after combining more than one medication, call your doctor right away.

The information in this chapter was taken from the Physician's Desk Reference, pharmaceutical company literature, and other reputable sources. It should be accurate as of this writing, but new information may emerge. Be sure to personally check out any medications you or your child takes using a detailed medication reference book, such as those listed in Appendix A, Resources (or the file named "Resources" on this website), to ensure that you are aware of all possible side effects and interactions. You should also consult the drug reference sheet packaged with your medication by the pharmacy.

Here are some more important do's and don'ts:

• Do not start or stop taking any prescription medication on your own.

• Be careful to follow exactly instructions about dosage, time, and accompaniment ("take with food," etc.).

• If you are pregnant or breastfeeding, or if you could become pregnant, ask your physician or pharmacist about any side effects specifically related to female reproduction and nursing.

• Men who are actively trying to father a child may also want to ask about male reproductive side effects.

• Be sure to tell both your physician and your pharmacist about all other medications you take, including over-the-counter drugs--even aspirin and cough syrup can cause dangerous side effects when mixed with the wrong medication.

• Inform your doctor about your use of alcohol, tobacco, any illegal drugs, and any vitamins or supplements (other than a regular daily multivitamin).

• If your doctor is unsure about how a medication might interact with a supplement, you may need to help him or her find more information about the chemical action of the supplement. Most doctors are not well informed about nutritional supplements or herbal medicines, but many are willing to work with you on these matters.

• If you suspect that you have been given the wrong medication or the wrong dosage, call your pharmacist right away. Such errors do occur, and your pharmacist should be able to either reassure you or fix the problem.

The latest data on medications for ASD symptoms

The following three tables summarize what's currently known about medications that address some symptoms of autism and other PDDs. They were adapted with permission from "New Findings on the Causes and Treatment of Autism" by Dr. Mark Potenza and Dr. Christopher McDougle, a 1997 article published in the medical journalCNS Spectrums (Copyright © 2001, Medical Broadcast Limited). They are based on information from the latest studies of human subjects who have autistic spectrum disorders. You can find out more about these studies by reading the original journal articles about them, all of which are listed in Notes at the end of this article.

You will notice that all these studies are fairly small: Of the 25 studies, 16 looked at fewer than ten people, 4 looked at only one person. None examined medication response based on ASD subgroups or individual factors. It is difficult to judge the efficacy of medications, based on these studies, but they are a start.

Table I - Drugs With Mixed 5-HT Receptor Agonism/Antagonism Properties in Pervasive Developmental Disorders (Click on "Table I" to view table.)

Table II - Selective Serotonin Reuptake Inhibitors in Pervasive Developmental Disorders. (Click on "Table II" to view table.)

Table III - "Atypical" Neuroleptics in Pervasive Developmental Disorders. (Click on "Table III" to view table.)

Medication List

• Antidepressants
  
• SSRIs
  
• MAOIs
  
• Tricyclics
  
• Catapres and Tenex
  
• Stimulants
  
• Medications for anxiety
  
• Antiseizure drugs
  
• Neuroleptics
  
• Atypical
  
• Other
  
• Antifungals
  
• Antivial and antibacterial drugs
  
• Other drugs
  

Within each category, medications are listed by US brand-name, followed by other brand-names where known. The generic name appears on the second line of each listing. Some of these drugs are not available commercially as low-cost generics. They may be marketed under other brand-names, and are not available in some countries.

Antidepressants

Antidepressants: The SSRIs

The brain is chock-full of serotonin receptors, tiny sites that bind with serotonin molecules to move chemical impulses through the brain. One type of antidepressants, the selective serotonin-reuptake inhibitors (SSRIs), block certain receptors from absorbing serotonin. Researchers believe this results in lowered or raised levels of serotonin in specific areas of the brain. Over time, SSRIs may cause changes in brain chemistry, hopefully in a positive direction. They may also cause actual changes in brain structure with prolonged use. There are also serotonin receptor sites elsewhere in the central and peripheral nervous systems, so SSRIs can affect saliva production, appetite, digestion, skin sensitivity, and many other functions.

Celexa, Cipramil

Generic name: citalopram

Use: ADD/ADHD.

Action, if known: CNS stimulant.

Side effects: Loss of appetite, weight loss, headache,

Known interaction hazards: None known.

Tips: Said to be smoother-acting than many other medications

Use Depression. Some doctors are, however, experimenting with this relatively new (to the US) SSRI to treat obsessive-compulsive behaviors. Although not yet FDA-approved for this purpose, limited clinical experience indicates citalopram is effective for some people.

Action, if known: Celexa increases the amount of active serotonin in the brain. It usually has a calming and/or sedating effect.

Side effects: Celexa can cause dry mouth, insomnia or restless sleep, increased sweating, and nausea. It is reportedly less likely to cause sexual dysfunction than other SSRIs. Celexa lowers the seizure threshold, and can cause mood swings in people with bipolar disorders.

Known interaction hazards: Celexa and alcohol can be a dangerous combo. Celexa should never be taken with an MAOI antidepressant, or soon after stopping an MAOI. Use Celexa with caution if you take a drug that affects the liver, such as ketoconazole or macrolide antibiotics.

Tips: People with liver or kidney disease need regular monitoring while taking Celexa.

Luvox, Faverin

Generic name: fluvoxamine maleate

Use: OCD, social phobia, depression. Luvox is FDA-approved for use by children aged 8 and older.

Action, if known: Luvox increases the amount of active serotonin in the brain. It usually has a calming and/or sedating effect.

Side effects: Luvox can cause headache, insomnia, sleepiness, nervousness, nausea, dry mouth, diarrhea or constipation, or sexual dysfunction. It lowers the seizure threshold, and can cause mood swings in people with bipolar disorders.

Known interaction hazards: Never take Luvox with an MAOI antidepressant, or soon after stopping an MAOI. Luvox's action is strengthened by tricyclic antidepressants and lithium. It can strengthen the action of many medications, including clozapine, diltiazem and perhaps other calcium channel blockers, methadone, some beta-blockers and antihistamines, and Haldol and other neuroleptics.

Tips: Avoid taking this drug if you have liver disease. Smoking cigarettes may make it less effective. Luvox does not bind to protein in the body, unlike the other SSRIs, and may have a very different effect in some people.

Paxil, Seroxat

Generic name: paroxetine hydrochloride

Use: OCD, panic disorder, social phobia, depression.

Action, if known: Paxil increases the amount of active serotonin in the brain. It usually has a calming and/or sedating effect.

Side effects: Paxil can cause headache, insomnia or restless sleep, dizziness, tremor, nausea, weakness, sexual dysfunction, or dry mouth. It lowers the seizure threshold, and can cause mood swings in people with bipolar disorders.

Known interaction hazards: Paxil should not be taken with alcohol. Never take it with an MAOI antidepressant, or soon after stopping an MAOI. Paxil strengthens the action of warfarin, theophylline, and procyclidine. It also changes how digoxin and phenytoin act in the body.

Tips: People with liver or kidney disease should be monitored regularly while taking Paxil. This medication has a short life in the body, so missed doses may be more likely to cause side effects. Some people who take Paxil for a long period and then stop suddenly experience unpleasant effects, occasionally including the onset of depression. To avoid these difficulties, always reduce your dose gradually under medical supervision.

Prozac

Generic name: fluoxetine hydrochloride

Use: OCD, depression. Prozac is also sometimes used to treat eating disorders, ADHD, narcolepsy, migraine/chronic headache, Tourette's syndrome, and social phobia.

Action, if known: SSRI-Prozac increases the amount of active serotonin in the brain. It may have an energizing effect.

Side effects: Prozac can cause headache, insomnia or restless sleep, dizziness, tremor, nausea, weakness, sexual dysfunction, dry mouth, itchy skin, and/or rash. It may cause changes in appetite and weight. Prozac lowers the seizure threshold, and can cause mood swings in people with bipolar disorders.

Known interaction hazards: Prozac should not be taken with alcohol or other central nervous system depressants. Never take this drug with an MAOI antidepressant, or soon after stopping an MAOI. Do not take OTC or prescription cold or allergy remedies containing cyproheptadine or dextromethorphan with Prozac. This drug's action is increased by tricyclic antidepressants. It strengthens the action of lithium, phenytoin, neuroleptic drugs, carbamazepine, and cyclosporine. It reduces the effectiveness of BuSpar.

Tips: Prozac has a long life in your body, and is metabolized slowly. People with liver or kidney disease should be monitored while taking Prozac.

Zoloft, Lustral

Generic name: sertraline hydrochloride

Use: OCD, panic disorder, depression. Zoloft is FDA-approved for use by children.

Action, if known: Zoloft increases the amount of active serotonin in the brain. It has an energizing quality.

Side effects: Zoloft can cause dry mouth, headache, tremor, diarrhea, nausea, or sexual dysfunction. It may cause mood swings, especially manic episodes, in people with bipolar disorders. It lowers the seizure threshold.

Known interaction hazards: Zoloft should not be taken with alcohol or any other central nervous system depressant. Never take this drug with an MAOI antidepressant, or soon after stopping an MAOI. Zoloft strengthens the action of benzodiazepine drugs and warfarin. Its action is strengthened by cimetidine. It may affect the therapeutic level of lithium.

Tips: People with liver or kidney disease need careful monitoring while taking Zoloft.

Antidepressants: the tricyclics

Before the SSRIs came along, the tricyclic antidepressants were considered the best medications available for treating depression and obsessive-compulsive behavior. Although these drugs tend to cause more side effects than the SSRIs, sometimes they are more effective for certain people. Anafranil is the tricyclic antidepressant most often prescribed to people with ASDs. Other tricyclics are listed later, but these are infrequently used.

Anafranil

Generic name: clomipramine hydrochloride

Use: Obsessive-compulsive behavior, depression, panic disorder, chronic pain, eating disorders, severe PMS. Anafranil is sometimes prescribed to treat herpes lesions or arthritis, indicating that it may also have antiviral or anti-inflammatory qualities. It is FDA-approved for use by children age 10 and older.

Action, if known: Anafranil blocks the reuptake of norepinephrine and serotonin, and works against the hormone acetylcholine. It has weak antihistamine properties.

Side effects: Anafranil can cause sedation, tremor, seizures, dry mouth, light sensitivity, mood swings in people with bipolar disorders, and weight gain. It lowers the seizure threshold, and can cause sexual side effects.

Known interaction hazards: Combining Anafranil with alcohol, MAOI antidepressants, blood pressure medications (including clonidine and guanfacine), or thyroid medication can be dangerous. Estrogen, bicarbonate of soda (as in Alka-Seltzer and other over-the-counter remedies), acetazolamide, procainamide, and quinidine all increase the activity of this drug. Cimetidine, methylphenidate, Thorazine and similar drugs (neuroleptics), oral contraceptives, nicotine (including cigarettes), charcoal tablets, and estrogen may interfere with Anafranil's action in the body.

Tips: Take Anafranil with food if stomach upset occurs. Take the bulk of your dose at bedtime to reduce sedation, if so directed.

Other tricyclic antidepressants

Antidepressants: MAOIs

A third class of antidepressants, the monoamine oxidase inhibitors (MAOIs), are also available-but they are rarely used. These medications are effective against depression by inhibiting the metabolism of the neurotransmitters serotonin, norepinephrine, and dopamine. They do so indirectly, by interfering with the enzyme monoamine oxidase (MAO). The MAOIs have unpleasant and even life-threatening interactions with many other drugs, including common over-the-counter medications. People taking MAOIs must also follow a special diet, because these medications interact with many foods. The list of foods to avoid includes chocolate, aged cheeses, beer, and many more. If you or your child must take a MAOI, familiarize yourself thoroughly with these dietary restrictions. The most frequently prescribed drugs in this class are Aurorix (moclobemide), Nardil (phenelzine), and Parnate (tranylcypromine sulfate). If your doctor prescribes a MAOI, read the package insert carefully, and learn more about its possible side effects from a medication reference book or your physician. Other antidepressants The following antidepressants work differently from the SSRIs, tricyclics, and MAOIs. They are among the newest medications that are occasionally prescribed to people with ASDs.

Reboxetine

Generic name: edronax

Use: Depression-Reboxetine tends to have an energizing effect.

Action, if known: A nontricyclic selective noradrenaline reuptake inhibitor (selective NRI), Reboxetine inhibits the reuptake of norepinephrine by cells, increasing noradrenaline availability in the synaptic cleft.

Side effects: Dry mouth, constipation, insomnia, sweating, heart irregularities, dizziness, urine retention, and sexual dysfunction are sometimes reported.

Known interaction hazards: Don't take Reboxetine with alcohol or other CNS depressants. It may interact with other antidepressants, and may change the way some antiseizure drugs work. If you take other medications, your doctor may need to adjust doses.

Tips: Reboxetine may counteract some of the interactions associated with MAOIs, and so it may be prescribed in concert with these. This combination should be monitored closely, of course. It is not currently available in the US.

Remeron

Generic name: mirtazapine

Use: Depression, anxiety.

Action, if known: Remeron is a noradrenergic and specific serotonergic antidepressant (NaSSA): it affects the neurotransmitter noradrenaline as well as some serotonin receptors. It has an energizing effect.

Side effects: Sleepiness, dry mouth, dizziness, weight gain, and constipation may occur when taking Remeron. It lowers the seizure threshold, and can cause mood swings in people with bipolar disorder. Remeron can depress the immune system, causing a lower count of white blood cells.

Known interaction hazards: Never take with an MAOI or soon after stopping an MAOI, and avoid alcohol, tranquilizers (including OTC sleep aids), and other CNS depressants when taking this medication.

Tips: If you experience fever, aches, sore throat, or infections, call your doctor. Take with food if stomach upset occurs. People with heart, liver, or kidney disease or hypothyroidism should be monitored while taking Remeron.

Serzone

Generic name: nefazodone

Use: Depression, especially if it occurs with agitation.

Action, if known: This drug blocks the uptake of serotonin and norepinephrine in the brain, and increases the levels of two natural antihistamines in the bloodstream.

Side effects: Sleepiness, dizziness, confusion, dry mouth, nausea, visual disturbances, and rashes are associated with Serzone. It lowers the seizure threshold.

Known interaction hazards: Never take Serzone with an MAOI, astemizole, propranalol, terfenadine, alprazolam, or triazolam. It strengthens the action of digoxin.

Tips: People with heart or liver trouble should be monitored while taking Serzone.

Wellbutrin, Zyban

Generic name: buproprion

Use: Depression, ADHD.

Action, if known: Wellbutrin is an aminoketone antidepressant: It appears to have mild effects on serotonin, dopamine, and norepinephrine. It is also a mild general CNS stimulant, affects the hormonal system, and suppresses appetite.

Side effects: Wellbutrin increases the risk of seizures. Restlessness, anxiety, insomnia, heart palpitations, dry mouth, rapid heartbeat or heart palpitations, tremor, and headache/migraine headache may occur when taking this drug.

Known interaction hazards: L-Dopa and ritonavir increase the effects of Wellbutrin. Its effects are decreased by carbamazepine. Do not use this medication with MAOIs, or with drugs or supplements that lower the seizure threshold.

Tips: Take Wellbutrin with food if stomach upset occurs. Be especially careful to start low, increase dose slowly, and limit dose size to reduce seizure risk.

Catapres and Tenex

Catapres

Generic name: clonidine

Use: High blood pressure, ADHD, tics/Tourette's syndrome, extreme impulsivity, migraine, drug and alcohol withdrawal aid, ulcerative colitis, childhood growth delay.

Action, if known: Clonidine stimulates alpha-adrenergic receptors in the brain and spinal cord to widen blood vessels, and stimulates similar receptors throughout the body. This reduces the heart rate, relaxes blood vessels, and may have other effects.

Side effects: This drug can cause dry mouth, dizziness, constipation, sedation, unusually vivid or disturbing dreams, and weight gain.

Known interaction hazards: Clonidine can interact with other medications for blood pressure, and its activity is blocked by tricyclic antidepressants, such as Anafranil. It can have an additive effect with certain antihistamines that also lower blood pressure.

Tips: Do not use clonidine if you have slow heart rate or AV node conduction problems, disease of the blood vessels in the brain, or chronic kidney failure. Clonidine is not recommended for people with depression. You can become tolerant of clonidine, requiring a higher dose. You should have regular eye exams, as clonidine can affect the retina. You can diminish oral clonidine's sedating effect by taking all or the largest part of your dose at bedtime. This can help people who have sleep problems. The time-released Catapres patch is far less sedating than oral clonidine for most people. Do not stop using clonidine suddenly. Your doctor can supervise a slow withdrawal program to avoid risking a sudden, dangerous rise in blood pressure. Symptoms of this problem include rapid heartbeat, sweating, nervousness, and headache. A cream version of clonidine is also available.

Tenex

Generic name: guanfacine

Use: High blood pressure, ADHD, tic disorders/Tourette's syndrome, migraines, extreme nausea, heroin withdrawal aid.

Action, if known: Guanfacine stimulates the central nervous system to relax and widen blood vessels, allowing freer blood flow and reducing blood pressure. It may also have other effects.

Side effects: Sleepiness, changes in blood pressure or heart rate, or nausea may occur.

Known interaction hazards: Alcohol and other CNS depressants plus guanfacine can cause extreme sedation. Its effects may be counteracted by stimulants such as Ritalin, many nonprescription drugs, estrogen and oral contraceptives, indomethacin, ibuprofen, and nonsteroidal anti-inflammatory drugs. It could also have an additive effect with certain antihistamines that also lower blood pressure.

Tips: If you take another medication that lowers blood pressure, your doctor will need to adjust your Tenex dose accordingly to prevent problems. Guanfacine's sedating effect can be diminished by taking all or the largest part of your dose at bedtime. This can help people who have sleep problems.

Stimulants

Stimulants are often prescribed to help with ADD and ADHD, which are fairly common in people with ASDs. However, doctors treating people with ASDs often note that they do not respond to these drugs as well as people who have ADD or ADHD alone. Indeed, adverse reactions or lack of benefit are frequently reported. These drugs have not been approved as treatments for ASDs. If stimulants are recommended, they should be used as part of a multifactor treatment plan, including behavior management and self-organization strategies.

Adderall

Generic name: dextroamphetamine/amphetamine

Use: ADHD.

Action, if known: Central nervous system (CNS) stimulant.

Side effects: Adderall can cause loss of appetite, weight loss, headache, insomnia, dizziness, increased heart rate, and agitation. It may increase tic severity in people with an underlying tic disorder.

Known interaction hazards: Vitamin C supplements, citrus juices, citric acid, more than four cans per day of soda pop, or taking this medication with food can reduce its effectiveness.

Tips: Make sure you drink plenty of water while taking Adderall, even if you're not thirsty. Adderall is not as well known as Ritalin, but it may be a better choice for many patients. It time-releases different amphetamine compounds smoothly over several hours, resulting in a lower chance of rebound.

Cylert

Generic name: pemoline

Use: ADHD, narcolepsy.

Action, if known: CNS stimulant.

Side effects: Cylert can cause irritability, insomnia, appetite changes, or depression. It lowers the seizure threshold.

Known interaction hazards: Cylert strengthens the action of other CNS stimulants. It may increase tic severity in people with an underlying tic disorder. Vitamin C supplements, citrus juices, citric acid, drinking more than four cans per day of soda pop, or taking this medication with food can reduce its effectiveness.

Tips: You will need to have liver enzyme tests frequently while taking Cylert-those with known liver problems may need to avoid this medication. It is not recommended for people with psychosis. You can take Cylert with food if stomach upset occurs, but the dose may need to be adjusted. Make sure you drink plenty of water, even if you're not thirsty. Cylert has a long action period, but because of the potential for liver problems and other complications it is rarely used unless all the other ADHD medications have failed to have positive effects and behavioral strategies are ineffective.

Dexedrine, Das, Dexampex, Dextrostat, Ferndex, Oxydess

Generic name: dextroamphetamine sulfate

Use: ADHD.

Action, if known: CNS stimulant.

Side effects: Dexedrine can cause agitation, restlessness, aggressive behavior, dizziness, insomnia, headache, tremor, dry mouth, change in appetite, or weight loss. It may raise blood pressure. It may increase tic severity in people with an underlying tic disorder.

Known interaction hazards: Do not use Dexedrine with MAOI antidepressants. It interacts with tricyclic antidepressants, meperidine, phenobarbital, phenytoin, propoxyphene, acetazolamide, thiazides, and some medications for stomach distress. Vitamin C supplements, citrus juices, citric acid, drinking more than four cans per day of soda pop, or taking this medication with food can reduce its effectiveness.

Tips: If you are diabetic, discuss your use of insulin and oral antidiabetes drugs with your doctor, as Dexedrine may force a change in dosage. It is not recommended for people with psychosis. Make sure you drink plenty of water, even if you're not thirsty, while taking this medication.

Desoxyn

Generic name: methamphetamine, MTH

Use: ADHD, narcolepsy.

Action, if known: CNS stimulant.

Side effects: Desoxyn can cause agitation, restlessness, aggressive behavior, dizziness, insomnia, headache, or tremor. It may raise your blood pressure. It may increase tic severity in people with an underlying tic disorder.

Known interaction hazards: Never use Desoxyn with an MAOI antidepressant. Its effects may be counteracted by barbiturates, tranquilizers (including OTC sleep aids), and tricyclic antidepressants. Desoxyn may strengthen the action of other CNS stimulants, including caffeine and OTC cold and allergy medications. Its action is strengthened by acetazolamide and sodium bicarbonate (found in Alka-Seltzer and similar over-the-counter remedies), and it may interact with thyroid hormones and some medications for gastrointestinal problems. Vitamin C supplements, citrus juices, citric acid, drinking more than four cans per day of soda pop, or taking this medication with food can reduce its effectiveness.

Tips: This is the most powerful and potentially addictive of the stimulants, and is well known as a drug of abuse. For these reasons, Desoxyn is rarely prescribed for ADHD in the US. If you are diabetic, discuss your use of insulin and oral antidiabetes drugs with your doctor, as Desoxyn may force a change in dosage. It is not recommended for people with psychosis. Make sure you drink plenty of water, even if you're not thirsty, while taking this medication.

Provigil

Generic name: modafinil

Use: ADHD, narcolepsy. Approved for narcolepsy only in the US.

Action, if known: CNS stimulant.

Side effects: Provigil can cause agitation, restlessness, aggressive behavior, dizziness, nausea, or insomnia. It may raise your blood pressure. Some people experience more infectious illnesses when taking this drug.

Known interaction hazards: Never use Provigil with an MAOI antidepressant. Its effects may be counteracted by barbiturates, tranquilizers (including OTC sleep aids), and tricyclic antidepressants. Provigil may strengthen the action of other CNS stimulants, including caffeine and OTC cold and allergy medications.

Tips: This medication is not recommended for people with psychosis.

Ritalin

Generic name: methylphenidate hydrochloride

Use: ADHD, narcolepsy, social phobia.

Action, if known: CNS stimulant.

Side effects: Ritalin can cause agitation, restlessness, aggressive behavior, dizziness, insomnia, headache, tremor, or loss of appetite and/or weight. It may raise your blood pressure. It may increase tic severity in people with an underlying tic disorder.

Known interaction hazards: Ritalin should not be taken with alcohol. Its action is strengthened by MAOI antidepressants to a high degree. It strengthens the action of tricyclic antidepressants, and reduces the action of guanethidine. Vitamin C supplements, citrus juices, citric acid, drinking more than four cans per day of soda pop, or taking this medication with food can reduce its effectiveness.

Tips: The rebound effect can be bad with Ritalin, which has the shortest life of the stimulants commonly used for ADHD. Some doctors combine Ritalin SR with regular Ritalin for the smoothest effect (SR's action is said to be erratic). Make sure you drink plenty of water, even if you're not thirsty. Some people, including quite a few doctors, swear that the brand-name Ritalin is superior to its generic counterpart. It may be worth trying the brand-name version if the generic didn't work well. A time-released version of Ritalin is now sold under the brand-name Concerta. It provides smooth delivery of medication throughout the day with a single morning dose, eliminating the need for taking medication at school or work, and potentially eliminating rebound effects.

Medications for anxiety

Antiseizure drugs

Cerebyx

Generic name: fosphenytoin

Use: Seizure disorders.

Action, if known: Cerebyx inhibits activity in the part of the brain where local focal (grand mal)seizures begin.

Side effects: Gum growth, confusion, twitching, depression, irritability, and many more side effects have been reported, some of which are very serious. Because of the many interaction problems with this drug, discuss it thoroughly with your doctor and pharmacist.

Known interaction hazards: Alcohol, aspirin, sulfa drugs, succinimide antiseizure medications, some neuroleptics and antidepressants, and many other drugs strengthen Cerebyx. Cerebyx increases the action of lithium, acetaminophen, and many other drugs. Its effects are changed by use of calcium, antacids, charcoal tablets, and many prescription drugs.

Tips: Do not use this drug if you have low blood pressure or heart trouble. Keep an eye out for skin rash or bruising, which can be serious warning signs. You may want to supplement with folic acid, which is depleted by Cerebyx. You will need to have regular blood tests while taking this drug. Take with food if stomach upset occurs-but not with high-calcium foods, such as dairy products, sesame seeds, or some nuts. Do not switch brands without telling your doctor.

Depakene

Generic name: valproic acid

Use: Seizure disorders, bipolar disorder, migraine, panic disorder, rages/aggression.

Action, if known: Depakene increases the levels of gamma-aminobutyric acid (GABA) in the brain, and increases its absorption. It also stabilizes brain membranes.

Side effects: Nausea, sedation, depression, psychosis, aggression, hyperactivity, and changes in blood platelet function can occur with Depakene.

Known interaction hazards: Do not take with milk, and do not use charcoal tablets. Be careful with alcohol and with any medication that has a

tranquilizing or depressant effect. Side effects may increase if: you use anticoagulants, including aspirin or nonsteroidal anti-inflammatory drugs, erythromycin, chlorpromazine, cimetidine, or felbamate.

Tips: Watch out for increased bruising or bleeding, an indicator of blood platelet problems. Regular liver tests are a must. Do not crush or chew tablets.

Depakote

Generic name: divalproex sodium (valproic acid plus sodium valproate)

Use: Seizure disorders, bipolar disorder, migraine, panic disorder, rages/aggression.

Action, if known: Depakote increases the levels of gamma-aminobutyric acid (GABA) in the brain, and increases its absorption. It also stabilizes brain membranes.

Side effects: Nausea, sedation, depression, psychosis, aggression, hyperactivity, and changes in blood platelet function are sometimes seen.

Known interaction hazards: Do not take with milk; do not use charcoal tablets. Be careful with alcohol and with any medication that has a tranquilizing or depressant effect. Side effects may increase if you use anticoagulants, including aspirin or nonsteroidal anti-inflammatory drugs, erythromycin, chlorpromazine, cimetidine, or felbamate.

Tips: Watch out for increased bruising or bleeding, an indicator of blood platelet problems. Regular liver tests are a must. Do not crush or chew tablets: A formulation called Depakote Sprinkles is available for those who can't take pills.

Dilantin

Generic name: Phenytoin

Use: Seizure disorders.

Action, if known: Dilantin inhibits activity in the part of the brain where tonic-clonic seizures begin.

Side effects: Gum growth, confusion, twitching, depression, irritability, and many more side effects have been reported, some of which are very serious. Because of the many interaction problems with this drug, discuss it thoroughly with your doctor and pharmacist.

Known interaction hazards: Alcohol, aspirin, sulfa drugs, succinimide antiseizure medications, some neuroleptics and antidepressants, and many other drugs make Dilantin stronger. It strengthens the action of lithium, acetaminophen, and many other drugs. Its effects are changed by use of calcium, antacids, charcoal tablets, and many prescription drugs.

Tips: Do not use this drug if you have low blood pressure or heart trouble. Keep an eye out for skin rash or bruising, which can be serious warning signs. You may want to supplement with folic acid, which is depleted by Dilantin. You will need to have regular blood tests while taking this drug. Take with food if stomach upset occurs-but not with high-calcium foods, such as dairy products, sesame seeds, or some nuts. Do not switch brands without telling your doctor.

Lamictal

Generic name: Lamotrigine

Use: Seizure disorders, Lennox-Gastaut syndrome in children.

Action, if known: Lamictal binds to the hormone melanin, stabilizes electrical currents within the brain, and blocks the release of seizure-stimulating neurotransmitters.

Side effects: Headache, dizziness, nausea, general flu-like feeling, and light sensitivity have been associated with Lamictal. If you develop a rash, call your doctor immediately as it may be a warning of a serious side effect. Lamictal may make seizures worse in some people.

Known interaction hazards: This drug interacts with Depakote, Depakene, carbamazepine, and phenytoin-your doctor will have to monitor doses carefully. Antifolate drugs make it stronger, whereas phenobarbital and primidone may lessen its effects.

Tips: This drug is not recommended for use by children. If you have heart, kidney, or liver disease, use it only under careful supervision.

Luminal, Solfoton

Generic name: phenobarbital

Use: Seizure disorder, insomnia.

Action, if known: Luminal, a barbiturate, blocks or slows nerve impulses in the brain. It is usually used in combination with another drug to control seizures.

Side effects: Drowsiness, slow reflexes, "stoned" feeling, allergy-like symptoms, and labored breathing may occur. Call your doctor if any side effect becomes bothersome, or if you develop anemia or jaundice. Luminal carries an addiction risk-taper off dose carefully if stopping.

Known interaction hazards: Alcohol, MAOIs, and Depakote/Depakene all strengthen Luminal. Alcohol should be avoided. It is neutralized by charcoal, chloramphenicol, and rifampin. Luminal makes acetaminophen (Tylenol) and the anesthetic methoxyflurane stronger. It changes the way many other drugs act in the body, including anticoagulants, beta-blockers, oral contraceptives, and corticosteroids. Be sure to go over all medicines you take with your doctor, as doses may need to be adjusted.

Tips: You may want to supplement with vitamin D when taking Luminal. People with liver or kidney disease should be monitored when taking this drug.

Mesantoin

Generic name: mephenytoin

Use: Seizure disorders.

Action, if known: Mesantoin inhibits activity in the part of the brain where local focal (grand ma) seizures begin.

Side effects: Gum growth, confusion, twitching, depression, irritability, and many more issues have been reported, some of which are very serious. Given the many interaction problems with this drug, discuss it thoroughly with your doctor and pharmacist.

Known interaction hazards: Alcohol, aspirin, sulfa drugs, succinimide antiseizure medications, some neuroleptics and antidepressants, and many other drugs strengthen Mesantoin. It strengthens lithium, acetaminophen, and many other drugs. Its effects are changed by use of calcium, antacids, charcoal tablets, and many prescription drugs.

Tips: Do not use this drug if you have low blood pressure or heart trouble. Keep an eye out for skin rash or bruising, which can be serious warning signs. You may want to supplement with folic acid, which is depleted by Mesantoin. You will need to have regular blood tests while taking this drug. Take with food if stomach upset occurs-but not with high-calcium foods, such as dairy products, sesame seeds, or some nuts. Do not switch brands without telling your doctor.

Mysoline

Generic name: primidone

Use: Seizure disorders.

Action, if known: Mysoline controls nerve impulses in the brain.

Side effects: Restlessness is often seen, especially in children. Dizziness, drowsiness, and rash are also reported.

Known interaction hazards: Avoid alcohol and all other CNS depressants, including tranquilizers, narcotics, and OTC sleep aids, allergy drugs, and cold medications. Mysoline may counteract corticosteroids, oral contraceptives, and blood-thinning medications. It may interact with other Depakote, Depakene, and other antiseizure drugs. Do not take Mysoline with MAOIs.

Tips: People with porphyria should not take Mysoline. If you have lung disease (including asthma), kidney disease, or liver disease, you will need to be carefully monitored while taking this drug.

Neurontin

Generic name: Gabapentin

Use: Seizure disorders, especially those that do not respond to other drugs; bipolar disorder, rage/aggression.

Action, if known: Neurontin appears to act by binding a specific protein found only on neurons in the CNS. It may increase the GABA content of some brain regions.

Side effects: Blurred vision, dizziness, clumsiness, drowsiness, swaying, and eye-rolling have been reported.

Known interaction hazards: Avoid alcohol and all other CNS depressants, including tranquilizers, OTC medications for colds and allergies, OTC sleep aids, anesthetics, and narcotics. Antacids may counteract the effects of Neurontin.

Tips: People with kidney disease should be carefully monitored while taking Neurontin. Corn is used as a filler in the usual formulation of this drug, causing allergic reactions in some. A new drug under development called Pregabolin is based on Neurontin, but with fewer side effects.

Peganone

Generic name: Ethotoin

Use: Seizure disorders.

Action, if known: Peganone inhibits activity in the part of the brain where local focal (grand mal) seizures begin.

Side effects: Gum growth, confusion, twitching, depression, irritability, and many more side effects have been reported, some of which are very serious. Because there are many interaction problems with this drug, discuss it thoroughly with your doctor and pharmacist.

Known interaction hazards: Alcohol, aspirin, sulfa drugs, succinimide antiseizure medications, some neuroleptics and antidepressants, and many other drugs strengthen the effects of Peganone. It strengthens lithium, acetaminophen, and many other drugs. Its effects are changed by use of calcium, antacids, charcoal tablets, and many prescription drugs.

Tips: Do not use this drug if you have low blood pressure or heart trouble. Keep an eye out for skin rash or bruising, which can be serious warning signs. You may want to supplement with folic acid, which is depleted by Peganone. You will need to have regular blood tests while taking this drug. Take with food if stomach upset occurs-but not with high-calcium foods, such as dairy products, sesame seeds, or some nuts. Do not switch brands without telling your doctor.

Tegretol

Generic name: carbamazepine

Use: Seizure disorders, nerve pain, bipolar disorder, rage/aggression, aid to drug withdrawal, restless leg syndrome, and Sydenham's chorea and similar disorders in children.

Action, if known: Tegretol appears to work by reducing polysynaptic responses.

Side effects: You may experience sleepiness, dizziness, nausea, unusual moods or behavior, headache, or retention of water. Tegretol may cause low count of white blood cells. Call your doctor right away if you have flu-like symptoms or other unusual reactions while taking this drug.

Known interaction hazards: Never take this drug with an MAOI. Tegretol is often used in combination with other antiseizure drugs, but the dose of Tegretol and drugs used with it must be very carefully adjusted. Tegretol is potentiated by numerous prescription and OTC medications, including many antibiotics, antidepressants, and cimetidine. It also counteracts or changes the effect of many drugs, including Haldol, theophylline, and acetaminophen. Because these interactions can be very serious, discuss all medications you take-including all OTC remedies-with your doctor before beginning to use Tegretol.

Tips: You should have a white blood cell count done before taking Tegretol and be monitored thereafter. Do not take if you have a history of bone marrow depression. Tegretol can be fatal at fairly low doses, so all patients taking this drug should be carefully monitored, particularly because it interacts with so many other medications.

Topamax

Generic name: topiramate

Use: Seizure disorders.

Action, if known: The mode of Topamax's antiseizure action is unknown.

Side effects: Problems reported include slowed speech, thought, and action; sleepiness; tingling in the extremities; nausea; tremor; depression; and visual disturbances.

Known interaction hazards: Avoid alcohol and other CNS depressants. Topamax interacts with other anti-epilepsy drugs, so your doctor may need to adjust dosages. It reduces the effectiveness of digoxin and oral contraceptives.

Tips: People with kidney or liver problems should be monitored while taking Topamax.

Zarontin

Generic name: ethosuximide

Use: Absence (petit mal) seizure disorders.

Action, if known: Zarontin is thought to reduce nerve signals within the brain.

Side effects: Nausea, abdominal pain, changes in appetite, weight loss, drowsiness, headache, dizziness, irritability, or insomnia may occur. Zarontin may lower the seizure threshold in some patients with mixed forms of epilepsy.

Known interaction hazards: This drug makes fosphenytoin, phenytoin, and ethotoin stronger.

Tips: You should have regular liver function and blood tests while taking this drug. Zarontin may cause systemic lupus erythematosus (a medication-caused form of lupus).

Neuroleptics

Atypical neuroleptics

Clozaril

Generic name: clozapine

Use: Schizophrenia, psychosis.

Action, if known: This drug works against the neurotransmitters acetylcholine and dopamine.

Side effects: Sedation, fever (this usually passes), changes in blood pressure or heartbeat, overproduction of saliva, and tremor are among the side effects connected with Clozaril. Major dangers include agranulocytosis (a serious blood condition), seizures, neuroleptic malignant syndrome (NMS), and tardive dyskinesia.

Known interaction hazards: Alcohol, CNS system depressants, drugs for high blood pressure, tricyclic antidepressants, and similar drugs should be avoided or used with caution. The danger of NMS increases when Clozaril is used with lithium.

Tips: Weekly blood tests are recommended for the first year of use, after which every four weeks will suffice if blood levels are stable. Women, people with low counts of white blood cells, and some people of Ashkenazi Jewish descent have a higher risk of agranulocytosis when taking this drug. People with heart disease, glaucoma, prostate trouble, or liver or kidney disease should be monitored carefully. Smoking cigarettes can affect how quickly your body metabolizes Clozaril.

Risperdal

Generic name: risperidone

Use: Psychosis, schizophrenia, rage/aggression.

Action, if known: Risperdal affects serotonin and dopamine, and raises the level of the hormone prolactin.

Side effects: You may experience sedation, headache, runny nose, anxiety, or insomnia while taking this drug. Weight gain, especially in children, is a concern. Risperdal carries a risk of neuroleptic malignant syndrome (NMS), tardive dyskinesia.

Known interaction hazards: Risperdal decreases the action of L-dopa. It interacts with carbamazepine and clozapine. It may strengthen the action of, or be strengthened by, SSRI antidepressants.

Tips: Doctors recommend having an EKG before starting Risperdal, and regular heart monitoring while taking it. In some patients, Risperdal (and possibly other atypical neuroleptics) may increase obsessive-compulsive symptoms.

Seroquel

Generic name: quetiapine

Use: Psychosis, rage/aggression.

Action, if known: Atypical neuroleptic-this drug is believed to increase the availability of serotonin and dopamine at specific receptors in the brain.

Side effects: Drowsiness, dizziness, sedation, agitation, nausea, changes in appetite, weight gain or loss, or sexual dysfunction may occur. Seroquel lowers the seizure threshold. It also carries a danger of neuroleptic malignant syndrome (NMS), extrapyramidal side effects, and tardive dyskinesia.

Known interaction hazards: The effects of this drug can be made dangerously strong by alcohol and all CNS depressants, including tranquilizers, sedatives, OTC sleep aids, and narcotics, as well as the anti-epilepsy drug phenytoin. It may interfere with the effects of drugs for high blood pressure. Seroquel's action may be increased by other drugs, including ketoconazole, erythromycin, clarithromycin, diltiazem, verapamil, and nefazodone.

Tips: This drug can cause extra-sensitivity to heat. People with liver or kidney problems, heart disease, thyroid problems, or low blood pressure should be monitored while taking Seroquel. You may want to supplement with vitamin E, which may protect against tardive dyskinesia.

Zeldox, Geodon

Generic name: ziprasidone

Use: Schizophrenia, psychosis, rage/aggression.

Action, if known: Zeldox affects the production and use of dopamine, serotonin, and norepinephrine. It also has some antihistamine effects, and is an alpha-adrenergic blocker.

Side effects: You may experience drowsiness, dizziness, agitation, tremor, nausea, reduced appetite, lightheadedness, rash, increased light sensitivity, increased blood pressure, or cold-like symptoms while taking Zeldox. It carries a risk of neuroleptic malignant syndrome (NMS) and tardive dyskinesia. Zeldox can lower the seizure threshold.

Known interaction hazards: Avoid alcohol and all CNS depressants, including tranquilizers, sedatives, OTC sleep aids, and narcotics. Zeldox may strengthen the action of drugs that lower your blood pressure, including Clonidine and Tenex. It may counteract L-dopa and similar drugs. Its action may be strengthened by carbamazepine and ketoconazole. According to its manufacturer, Pfizer, Zeldox is less likely to interact with other medications than other atypical neuroleptics.

Tips: Before starting Zeldox, you should have an EKG, as well as regular heart monitoring while taking this drug. It should not be used with other drugs that affect the QT interval, including quinidine, dofetilide, pimozide, thioridazine, moxifloxacin, and sparfloxicin. It is not recommended for people with existing heart or liver problems, or for people with altered electrolyte balance (such as people with anorexia). Zeldox is a very new drug, and just received FDA approval for US use in February 2001. According to research carried out by its manufacturer, it is much less likely to cause rapid weight gain than other atypical antipsychotics, and may be safer for people who have diabetes or high cholesterol because it has less effect on insulin and cholesterol. Zeldox capsules contain lactose, so if you are lactose intolerant you may want to use a lactose-free version if available. Zeldox may increase the risk of birth defects in the children of women who take it. Talk to your doctor if you could become pregnant.

Zyprexa

Generic name: olanzapine

Use: Psychosis, rage/aggression, tics; also used in cases of hard-to-treat OCD, depression (usually with an antidepressant), or bipolar disorders (usually with a mood stabilizer).

Action, if known: This medication blocks uptake of dopamine and serotonin at certain receptors, and may have other actions.

Side effects: You may experience headache, agitation, dry mouth, hostility, disinhibition, insomnia, or slurred speech while taking this drug. Other risks include neuroleptic malignant syndrome (NMS), tardive dyskinesia, dizziness, and seizures.

Known interaction hazards: Alcohol and carbamazepine add to the sedating action of this drug. Zyprexa strengthens the effect of medications for high blood pressure, including clonidine and guanfacine.

Tips: Zyprexa can increase your sensitivity to heat. If you smoke, you may need to take Zyprexa more frequently, as nicotine increases the metabolism of this drug.

Other neuroleptics

Antifungals

Diflucan

Generic name: fluconazole

Use: Yeast infections.

Action, if known: Diflucan inhibits an enzyme that occurs in Candida albicans and other yeasts.

Side effects: Some patients report unpleasant "die-off" reactions as yeast in the GI tract are killed.

Known interaction hazards: Diflucan strengthens the action of certain drugs for diabetes, causing low blood sugar. It also strengthens cyclosporine, phenytoin, theophylline, warfarin, and zidovudine. It is strengthened by hydrochlorothiazide, and may cause oral contraceptives to be ineffective.

Tips: Call your doctor if you develop a rash while taking Diflucan.

Lamisil

Generic name: terbinafine hydrochloride

Use: Lamisil is used to treat fungal infection of the skin or nails, including Candida.

Action, if known: This drug kills fungal organisms.

Side effects: The cream can cause itching or irritated skin; headache, diarrhea, or rash can occur when taking oral Lamisil.

Known interaction hazards: Cimetidine, terfenadine, and rifampin make Lamisil stronger. It may counteract cyclosporin. It enhances the effect of caffeine.

Tips: Do not take this drug with food. People with kidney or liver disease should be carefully monitored when taking Lamisil.

Mycostatin, Mykinac, Nilstat, Nystex

Generic name: nystatin

Use: Fungal and yeast infections.

Action, if known: This drug kills fungi by chemically binding to their cell membranes, causing cell contents to leak out.

Side effects: Nausea and diarrhea are often reported. Some people note uncomfortable "die-off" reactions during the treatment as yeast in the GI tract is killed.

Known interaction hazards: None known.

Tips: None.

Monistat

Generic name: miconazole

Use: Monistat is used to treat fungal or yeast infections.

Action, if known: Antifungal.

Side effects: Nausea and diarrhea are reported. Some people note uncomfortable "die-off" reactions during the treatment as yeast in the GI tract is killed.

Known interaction hazards: None.

Tips: None.

Nizoral

Generic name: ketoconazole

Use: Nizoral is used to treat fungal infections. It is not very effective if the infection is in the nervous system, however.

Action, if known: It invades the outer membrane of fungal cells, destroying them.

Side effects: Headaches, dizziness, drowsiness, nausea, and itching are reported. It decreases the level of the hormone testosterone, so men may experience swollen breasts. It also reduces the level of natural steroids in the body, which may depress the immune system. Nizoral can cause liver inflammation-call your doctor immediately if you see signs of jaundice or have abdominal pain.

Known interaction hazards: Do not take Nizoral with antacids or histamine H2 antagonists. It interacts with corticosteroid drugs, cyclosporine, cisapride, some antihistamines, phenytoin, and theophylline.

Tips: Take this medication with food.

Sporonax

Generic name: itraconazole

Use: Sporonax is used to treat fungal infections.

Action, if known: This drug inhibits enzymes within fungi living in the body, eventually killing them.

Side effects: Nausea, rash, water retention, and sexual dysfunction may occur.

Known interaction hazards: Never take Sporonax with astemizole or terfenadine. Avoid taking it with amlodipine or nefedipine. Sporonax strengthens the action of cisapride, digoxin, some medications for diabetes, phenytoin, quinidine, tacrolimus, and warfarin. It may be counteracted by cimetidine, ranitidine, famotidine, nazatidine, isoniazid, phenytoin, and rifampin.

Tips: People with liver disease should be monitored while taking Sporanox.

Antivial and antibacterial drugs

Ampligen

Generic name: poly I: poly C12U

Use: This drug has been tried as a treatment for AIDS, chronic fatigue immune deficiency syndrome (CFIDS, myalgic encephalopathy), fibromyalgia, and hepatitis B and C.

Action, if known: Ampligen is a nucleic acid (NA) compound that apparently heightens production of the body's own immunological and antiviral agents, such as interferon, and boosts natural killer (NK) cell and monocyte activity. It is said to inhibit the growth of viruses and tumor cells.

Side effects: Dizziness and facial flushing have been reported. Anecdotal reports from long-term users warn of heart problems and cancer risks, although these have not been proven. Ampligen is given via IV infusion, which carries minor infection risks and can cause discomfort.

Known interaction hazards: None known, but likely to be comparable with other drugs of this type.

Tips: Ampligen is experimental, and may have hazards, actions, and benefits that are as yet unknown. It is also expensive. Some patients with CFIDS and other disorders who have obtained it are staunch supporters, others report major problems. It is available in Canada, some parts of Europe, and via clinical trials.

Foscavir

Generic name: foscarnet sodium, trisodium phosphonoformate

Use: Foscavir is used to treat infection with human herpes viruses, cytomegalovirus, HIV/AIDS, and other viruses. It can cross the blood-brain barrier.

Action, if known: An immune modulator, this drug inhibits viral reproduction.

Side effects: Nausea, tremor, twitchiness, anemia, and electrolyte imbalance in the blood have been reported. Foscavir carries a toxicity risk, can cause kidney problems, and lowers the seizure threshold. Foscavir is given via IV infusion, which carries minor infection risks and can cause discomfort.

Known interaction hazards: May interact with acyclovir, amphotericin, calcium chloride, calcium folinate, calcium gluconate, co-trimoxazole, diazepam, digoxin, diphenhydramine, dobutamine, droperidol, ganciclovir, Haldol and similar drugs, lorazepam, midazolam, pentamidine, prochlorperazine, promethazine, and vancomycin-your doctor may need to adjust your doses carefully if you take one or more of these drugs.

Tips: You will need to have regular kidney function checks while taking Foscavir. You may want to take a calcium supplement. Make sure to drink extra water. Intravenous procedures should always be done in a setting where resuscitation equipment and trained personnel are available. A topical numbing agent may decrease discomfort from needle insertion.

Isoprinosine, Inosiplex, Immunovir

Generic name: inosine pranobex

Use: Isoprinosine is used to treat infection with human herpes viruses and other viruses, including cytomegalovirus, Epstein-Barr, varicella, measles, HIV/AIDS, hepatitis.

Action, if known: This immune modulator inhibits human herpes viruses and other infections by mimicking the effect of hormones produced by the thymus gland.

Side effects: Unknown, although any type of hormone or hormone analog supplementation can be hazardous.

Known interaction hazards: Unknown

Tips: This is a relatively new drug in the potential ASD arsenal, and its effectiveness unknown. It is not approved for use in the US.

Kutapressin

Generic name: kutapressin, KU

Use: This immune modulator is used to treat human herpes viruses, including herpes zoster (shingles).

Action, if known: A porcine (pig) liver extract, kutapressin strengthens the action of bradykinin, and inhibits human herpes viruses and Epstein-Barr virus.

Side effects: None known, but probably similar to other drugs of this type. The fact that it is an animal extract could be problematic for some caused by possible antibody cross-reactivity or viruses, although there have been no reports of these problems.

Known interaction hazards: None known.

Tips: Kutapressin is administered via intramuscular (IM) injection. A topical numbing agent may decrease discomfort from needle insertion. Most doctors feel that kutapressin's effectiveness has been far outstripped by more recent antivirals.

Valtrex

Generic name: valacyclovir hydrochloride

Use: Valtrex works against herpes zoster and other herpetiform viruses.

Action, if known: Valtrex is converted into the antiviral acyclovir in the liver and intestine. Acyclovir battles the herpes viruses by inhibiting an enzyme they need to reproduce.

Side effects: Headache, bowel complaints, dizziness, nausea, and loss of appetite are reported.

Known interaction hazards: Valtrex can cause loss of energy and sedation when combined with zidovudine to create AZT. It is strengthened by cimetidine and probenecid.

Tips: Valtrex should not be taken by people with serious immune system suppression, including AIDS.

Venoglobulin S, Polygam, Gammagard

Generic name: intravenous immunoglobulin (IVIG)

Use: IVIG is used to treat bacterial or viral infection that does not respond to other therapies, Kawasaki disease, idiopathic thrombocytopenic purpura, autoimmune disorders, and recurrent miscarriage from autoimmune activity.

Action, if known: Gamma globulin is the component of human blood that contains antibodies. When injected into the body, it provides (presumably temporary) passive immunity to those infections for which it has antibodies, and also decreases the activity of natural killer (NK) cells.

Side effects: Fever, chills, headache, nausea, and back pain may occur. Gamma globulin could also contain viruses, despite careful screening. Some lots were withdrawn from the market in 1998 for this reason. Any intravenous procedure can have side effects ranging from mild discomfort to death.

Known interaction hazards: None known.

Tips: Before receiving IVIG, you should have a quantitative immune-globulin panel blood test to make sure you do not have this deficiency, which can lead to anaphylactic shock. Drink plenty of water or other liquids before, during, and after your IVIG infusion. Benadryl may help with side effects. Intravenous procedures should always be done in a setting where resuscitation equipment and trained personnel are available. A topical numbing agent may decrease discomfort from needle insertion. Note that as far as we can tell, only the three brands mentioned screen their IVIG for hepatitis C.

Zovirax

Generic name: acyclovir

Use: Zovirax is used to treat infection with human herpes viruses, Epstein-Barr virus, varicella (chicken pox) and varicella pneumonia, cytomegalovirus, and other viruses.

Action, if known: This immune modulator inhibits the growth of viruses from within by interfering with reproduction of viral DNA.

Side effects: Sore or bleeding gums, fever, dizziness, headache, digestive trouble, diarrhea, rash, and insomnia may occur.

Known interaction hazards: Oral probenecid strengthens this drug's action. Sleepiness may occur when combined with zidovudine.

Tips: Take Zovirax with food if stomach upset occurs.

Other drugs

Gastrocom

Generic name: cromolyn

Use: Prevention of allergic reaction to foods.

Action, if known: Prevents mast cells from releasing antihistamines, reducing allergic reactions; may block absorption of allergens.

Side effects: Headache, diarrhea, allergy attacks.

Known interaction hazards: Do not take with food, juice, or milk.

Tips: People with heart, kidney, or liver problems should be monitored when taking Gastrocom. You can take Gastrocom with water, and you may dissolve the contents in hot water to drink it.

Habitrol, Nicoderm, Nicotrol, ProStep

Generic name: nicotine

Use: Used as an aid to stopping smoking, but sometimes prescribed to strengthen the action of neuroleptic drugs without increasing the actual dose.

Action, if known: Nicotine affects many CNS functions, and not all its actions are known. It may reduce tics and anxiety in some people.

Side effects: Diarrhea, insomnia, and nervousness may occur. Addiction is possible.

Known interaction hazards: Caffeine interferes with nicotine absorption.

Tips: People with insulin-dependent diabetes, heart problems, liver or kidney disease, high blood pressure, or pheochromocytoma should be carefully monitored when using nicotine in any form (including cigarettes).

Nitoman, Regulin

Generic name: tetrabenazine, TDZ

Use: This is the only drug currently known to help with tardive dyskinesia. It is also used to treat dystonia, Huntington's chorea, and Tourette's syndrome.

Action, if known: Tetrabenazine depletes dopamine in nerve endings in the brain.

Side effects: Depression is a well-known side effect.

Known interaction hazards: It may interact with other drugs that affect dopamine production or use.

Tips: Available in Canada, Norway, Sweden, the UK, and Japan, tetrabenazine can be obtained only through compassionate use programs in the US.

ReVia

Generic name: naltrexone hydrochloride

Use: ReVia is primarily used as a heroin/opioid and alcohol addiction withdrawal aid.

Action, if known: It is an opioid antagonist: It blocks opioid chemicals.

Side effects: Anxiety, nervousness, insomnia, abdominal discomfort, nausea, headache, muscle or joint pain may occur.

Known interaction hazards: Avoid alcohol and all CNS depressants, including anesthetics, narcotics, and sedatives. ReVia may block the effects of these substances until they reach a critical, even deadly, level.

Tips: People with liver problems must be closely monitored while taking ReVia. This drug has been tested for use in autism with mixed results.

Secretin

Generic name: secretin

Use: Secretin is used to test GI tract function. It is being tested as an experimental therapy for autistic spectrum disorders.

Action, if known: Secretin is a polypeptide hormone produced in the small intestine to stimulate pancreatic fluid secretion and biliary epithelial excretion, including immunoglobulins. It is known to target receptors in the GI tract and brain, and to affect intracellular cAMP and neurotransmitter production, probably including serotonin. Recent studies indicate that it targets the amygdala in particular. It may break down potentially aggravating peptides, such as those produced in response to gluten and casein.

Side effects: No major side effects should be expected from one-time use, but this medication has not been thoroughly tested for repeated use. Some children who have received infusions of secretin have not responded; a few have developed new and difficult symptoms. Parents have reported fever, runny noses, and coughing during the week following infusion. Some doctors have expressed concern that antibodies in porcine (pig) secretin could cross-react with human secretin, perhaps causing the body to stop producing any of its own secretin, or causing other health problems. Synthetic human secretin might be safer, but has not yet been widely used.

Known interaction hazards: None yet known, although some doctors have advised that supplements, megavitamin therapy, antifungals, antibiotics, and some medications may interfere with the action of secretin.

Tips: Intravenous procedures should always be done in a setting where resuscitation equipment and trained personnel are available. A topical numbing agent may decrease discomfort from needle insertion. Some doctors administering secretin recommend testing for certain antibodies or health conditions before and after infusion. Some also recommend dietary changes and courses of certain medication for several months in advance of trying secretin. This is a very new therapy for autistic spectrum disorders, so you will want to work closely with your physician. It may be possible to increase the body's own production of secretin rather than administering it directly. Substances that may have this effect include phenylpentol, methanol extract of licorice root, plaunotol, and teprenon.

Notes

1. G. M. Realmuto, G. J. August, and B. D. Garfinkel, "Clinical effect of buspirone in autistic children," Journal of Clinical Psychopharmacology 9 (1989): 122-125.

2. J. J. Ratey et al., "Buspirone therapy for maladaptive behavior and anxiety in developmentally disabled persons." Journal of Clinical Psychiatry 50 (1989): 382-384.

3. A. Gedye, "Buspirone alone or with serotonergic diet reduced aggression in a developmentally disabled adult." Biological Psychiatry 30 (1991): 88-91.

4. J. J. Ratey et al., "Buspirone treatment of aggression and anxiety in mentally retarded patients: A multiple baseline, placebo lead-in study." Journal of Clinical Psychiatry 52 (1991): 159-162.

5. R. W. Ricketts et al., "Clinical effects of buspirone on intractable self-injury in adults with mental retardation." Journal of the American Academy of Child and Adolescent Psychiatry 33 (1994): 270-276.

6. C. T. Gordon et al., "A Double-blind comparison of clomipramine, desipramine, and placebo in the treatment of autistic disorder." Archives of General Psychiatry 50 (1993): 441-447.

7. C. J. McDougle et al., "Clomipramine in autism: Preliminary evidence of efficacy." Journal of the American Academy of Child and Adolescent Psychiatry 31 (1992): 746-750.

8. H. J. Garber et al: Clomipramine treatment of stereotypic behaviors and self-injury in patients with developmental disabilities. Journal of the American Academy of Child and Adolescent Psychiatry 31:1157-1160, 1992.

9. J. R. Brasic et al., "Clomipramine ameliorates adventitious movements and compulsions in prepubertal boys with autistic disorder and severe mental retardation." Neurology 44 (1994): 1309-1312.

10. E. S. Brodkin et al., "Clomipramine in adults with pervasive developmental disorders: A prospective Open-label investigation." Journal of Child and Adolescent Psychopharmacology (1997), in press.

11. L. E. Sanchez et al., "A pilot study of clomipramine in young autistic children." Journal of the American Academy of Child and Adolescent Psychiatry 35 (1996): 537-544.

12. C. J. McDougle et al., "Effects of tryptophan depletion in drug-free adults with autistic disorder." Archives of General Psychiatry 53 (1996): 993-1000.

13. E. H. Cook Jr. et al., "Fluoxetine treatment of children and adults with autistic disorder and mental retardation." Journal of the American Academy of Child and Adolescent Psychiatry 31 (1992): 739-745.

14. A. Zuddas et al., "Clinical effects of clozapine on autistic disorder" (letter), American Journal of Psychiatry 153 (1996): 738, 1996.

15. S. E. Purdon et al., "Risperidone in the treatment of pervasive developmental disorder." Canadian Journal of Psychiatry 39 (1994): 400-405.

16. C. J. McDougle et al., "Risperidone in adults with autism or pervasive developmental disorder." Journal of Child and Adolescent Psychopharmacology 5 (1995): 273-282.

17. J. G. Simeon et al, "Risperidone effects in treatment-resistant adolescents: Preliminary case reports." Journal of Child and Adolescent Psychopharmacology 5 (1995): 69-79.

18. S. Fisman et al., "Case study: Anorexia nervosa and autistic disorder in an adolescent girl." Journal of the American Academy of Child and Adolescent Psychiatry 35 (1996): 937-940.

19. H. B. Demb, "Risperidone in young children with pervasive developmental disorders and other developmental disabilities" (letter), Journal of Child and Adolescent Psychopharmacology 6 (1996):79-80.

20. S. Fisman and M. Steele, "Use of risperidone in pervasive developmental disorders: A case series." Journal of Child and Adolescent Psychopharmacology 6 (1996): 177-190.

21. A. Hardan et al., "Case study: Risperidone treatment of children and adolescents with developmental disorders," Journal of the American Academy of Child and Adolescent Psychiatry 35 (1996): 1551-1556.

22. M. Rubin, "Use of atypical antipsychotics in children with mental retardation, autism, and other developmental disabilities," Psychiatric Annals 27 (1997): 219-221.