Medication Reference Tables

Note: The following tables are part of a Medical Reference article. Please see the full article for additional information relating to these tables.
The following excerpt is taken from Appendix E of Autistic Spectrum Disorders: Finding a Diagnosis and Getting Help by Mitzi Waltz, copyright 2002 by O'Reilly & Associates, Inc. For book orders/information, call 1-800-998-9938. Permission is granted to print and distribute this excerpt for noncommercial use as long as the above source is included. The information in this article is meant to educate and should not be used as an alternative for professional medical care.

The latest data on medications for PDD symptoms

The following three tables summarize what's currently known about medications that address some symptoms of autism and other ASDs. 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 © 1997, 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 at the end of the Medication Reference article.

Table I - Drugs With Mixed 5-HT Receptor Agonism/Antagonism Properties in Pervasive Developmental Disorders

Reference Study Design N Age (yrs) Dosage (mg/day) Duration (weeks) Efficacy Adverse Effects

Buspirone

Realmuto and others (1989)1 Open-
label with blinded comparison to fenfluramine or methy-
lphenidate 		4 Range, 9-10 Mean 9.3 15 4 Improvement in hyperactivity (2/4), aggression (2/4), & stereotypy (2/4) None
Ratey and others (1989) 2 Open-
label 		14 (3 with ASDs) Range, 23-63 (25-38) Mean, 35.3 (32.2) 15-45 26-52 in well-
described cases 		Improvement in 9/14, with decreases in aggression and ritualistic behavior, and increases in social interactions None reported

Gedye (1991) 3

Single-blind, ABAC design, open comparison to serotonin-
enhancing diet

1

39

20

10 active

Decrease in aggression (65-76%)

None

Ratey and others (1991) 4

Multiple baseline, placebo lead-in, ABC design

6 (1 with PDD)

Range, 18-50 (29) Mean, 28.4 (29)

15-45

9 active

Improvement with decreases in self-injurious behavior and anxiety

None reported

Ricketts and others (1994) 5

Open-
label

5 (3 w/ ASDs)

Range, 27-45 (27-34) Mean, 34.6 (30)

Range, 30-60 (30-60) Mean, 49.5 (45)

6-33

Decrease in aggression (13-72%)

None

Trazodone

Gedye (1991)3

Open-
label, ABAB design

1

17

50-150

10 active

Decrease in aggression (70-79%)

None reported

 

Table II - Selective Serotonin Reuptake Inhibitors in Pervasive Developmental Disorders

Reference

Study Design

N

Age

(yrs)

Dosage)

(mg/day)

Duration (weeks)

Efficacy

Adverse Effects

Clomipramine

Gordon and others (1993)6

Double-
blind crossover

12 vs DMI

12 vs PLA

Range, 6-18

Mean, 9.7

152+/-56

5

CMI>DMI, CMI>PLA for stereotypies, anger, rituals; CMI=DMI>PLA for hyperactivity

Insomnia, constipation, sedation, twitching, EKG changes (N=1), tachycardia (N=2), grand mal seizure

McDougle and others (1992)7

Open-
label

5

Range, 13-33

Mean, 25.2

185+/-74

12

4/5 patients showed improved social relatedness and reduced repetitive behavior and aggression

Dry mouth

Garber and others (1992)8

Open-
label

11

Range, 10-20

Mean, 15.0

70+/-37

4-52

10/11 patients had >50% reduction in SIB and stereotypies

Hypomania, constipation, sedation, enuresis, aggression

Brasic and others (1994)9

Open-
label

5

Range, 6-12

Mean, 9.4

200+/-0.0

8-78

5/5 patients showed reduced adventitious movements and compulsions

None reported

Brodkin and others (in press, 1997)10

Open-
label

35

Range, 18-44

Mean, 30.2

139+/-50

12

18/35 patients "much improved" or "very much improved," with reduced repetitive behavior, aggression, and echolalia

Constipation, sedation, weight gain, seizures (N=3)

Sanchez and others (1996)11

Open-
label

8

Range, 3.5-8.7

Mean, 6.4

103.6

5

7 patients worse, 1 moderately improved

Urinary retention, constipation, insomnia, sedation, aggression

Fluvoxamine

McDougle and others (1996)12

Double-
blind parallel groups

30

Range, 18-53

Mean, 30.1

277+/-42

12

8/15 patients "much improved" or "very much improved" on fluvoxamine, 0/15 patients improved on placebo. Reduced repetitive behavior and aggression and improved language usage

Nausea, sedation

Fluoxetine

Cook and others (1992)13

Open-
label

23

Range, 7.0-28.8

Mean, 15.9

28.3

1.5-67

15/23 patients had an improvement of 1 or more on CGI Severity Rating. Reduced rituals and aggression, better eye contact

Agitation, hyperactivity, insomnia, "elated affect," decreased appetite, increased screaming

McDougle and others (unpublished data)

Open-
label

42

Range, 18-39

Mean, 26.1

122+/-61

12

24/42 patients "much improved" or "very much improved." Improvement seen in repetitive behavior and aggression

Agitation, headaches, reduced appetite,sedation, weight gain

CGI = Clinical Global Impression Scale; CMI = clomipramine; DMI = desipramine; N = number of subjects; PLA = placebo; SIB = self-injurious behavior.

 

Table III - "Atypical" Neuroleptics in Pervasive Developmental Disorders

Reference

Study Design

N

Age (yrs)

Dosage (mg/day)

Efficacy

Adverse Effects

Clozapine

Zuddas and others (1996)14

Open-
label

3

Range, 8-12

Mean, 9.33

200-400

Improvements in hyperactivity, SIB, aggression, and communication

Transient sedation, enuresis

Risperidone

Purdon and others (1994)15

Open-
label

2

Range, 29-30

Mean, 29.5

6-8

Improvements in hyperactivity, social interactions, repetitive behaviors

None reported

McDougle and others (1995)16

Open-
label

3

Range, 20-44

Mean, 31.67

2-8

Improvements in social relatedness, repetitive thoughts and behaviors, and impulsive aggression

None

Simeon and others (1995)17

Open-
label

7 (2 with PDD)

Range, 11-17

Mean, 14.43

(Range, 13-14

Mean 13.50)

1-4

Improvements in social interactions and aggressive behaviors

None (transient sedation at higher doses)

Fisman and others (1996)18

Open-
label

1

14

1

Decrease in compulsive avoidances and agitation, and improved attention

None

Demb (1996)19

Open-
label

3

Range, 5-11

Mean, 7.66

1-3

Decreases in SIB and hyperactivity

Temporary sedation, extrapyramidal side effects, weight gain

Fisman & Steele (1996)20

Open-
label

14

Range, 9-17

Mean, 12.72

0.75-1.5

Improvement (13/14) with decreases in disruptive behaviors, agitation, anxiety, and repetitive behaviors; and increased social awareness and attention

Initial sedation (5/14), sleep onset insomnia (1/14), rhinorrhea (1/14), and transient headache (1/14)

Hardan and others (1996)21

Open-
label

20

Range, 8-17

Mean, 13.35

1.5-10

Improvement (13/20) with decreases in aggression, SIB, impulsivity, hyperactivity, and psychosis

Weight gain (3/20), galactorrhea (2/20 [2/7 girls])

Rubin (1977)22

Open-
label

2

Range, 3.5-5 Mean, 4.25

Improvement with decreases in repetitive and aggressive behaviors, and increased social function

None

Olanzapine

Rubin (1997)22

Open-
label

1

17

30

Decrease in pacing and aggression, and stabilization of mood

None

N = number of subjects; SIB = self-injurious behavior.

Note: The preceding tables are part of a Medical Reference article. Please see the full article for additional information relating to these tables.

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