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1 Psychotropic Medication List Recommended dosages are intended to serve only as a guide for children. Recommended doses are literature based. Clinicians should consult package insert of medications for a full review. This is not a comprehensive list. Not all medications prescribed for psychiatric diagnoses in children and adolescents are included. Medication Name Age group Recommended dosing Schedule FDA & literature based indications Warnings, precautions, additional info Antidepressants Fluoxetine (Prozac) mg Daily MDD, OCD Black box warning Insomnia, sedation, headache, GI effects, activation, black box warning suicidal thoughts labs: CBC, thyroid (baseline and as ) Escitalopram (Lexapro) mg Daily MDD (ages 12+) Insomnia, sedation, headache, GI effects, Citalopram (Celexa) mg Daily None Insomnia, sedation, headache, GI effects, labs: CBC, thyroid and EKG (baseline and as ) Sertraline (Zoloft) mg Daily OCD (ages 6+) Insomnia, sedation, headache, GI effects, Fluvoxamine (Luvox) mg Daily OCD (ages 8+) Insomnia, sedation, headache, GI effects, Paroxetine (Paxil) mg Daily Anxiety, depression Insomnia, sedation, headache, GI effects, Buproprion (Wellbutrin SR/XL) 6+ 75mg mg (SR/XL teens) daily & MDD (ages 12+) Headache, agitation, weight loss, restless insomnia, sweating, tremor, hypertension
2 Duloxetine (Cymbalta) Venlafaxine (Effexor, Effexor XR) Desvenlafaxine (Pristique) Mirtazapine (Remeron) Trazodone (Desyrel) Chlomipramine (Anafranil) Amitriptyline (Elavil) Imipramine (Tofranil) Nortriptyline (Pamelor) Anxiolytics Clonazepam (Klonopin) Propranolol (Inderal) Buspirone (BuSpar) mg Daily & mg IR: 2 3x day GAD anxiety Nausea, insomnia, sexual dysfunction, sweating, hypertension, discontinuation syndrome. CBC, lytes, thyroid (baseline and as ) Nausea, insomnia, sexual dysfunction, sweating, hypertension, discontinuation syndrome. CBC, lytes, thyroid (baseline and as ) XR: daily mg Daily Anxiety, depression Activation, discontinuation issues, severe skin rashs CBC, lytes, thyroid mg Daily Anxiety, depression, Weight gain (hangry), hypotension, seizures, sleep neutropenia mg daily Sleep, reports of use in QT prolongation, priapism, serotonin syndrome, ADHD with low discontinuation, cognitive impairment dosing mg Daily Depression, anxiety, OCD mg mg/kg/day 100mg mg 100mg mg/kg 0.08mg/kg mg/kg 60mg mg Migraines, depression, anxiety Nocturnal enuresis (ages 6+) Depression Panic, agitation Social anxiety, panic attacks Anxiety, agitation, panic Rebound agitation, memory impairment, irritability, aggression, emotional blunting, depression Arrhythmias, tremor, HTN, headache, fatigue, Stevens Johnson Rash Drowsy, dizzy, nausea, headache, depression, agitation, TD and EPS
3 Mood Stabilizers Topiramate (Topamax) Divalproex (Depakote) Lamotrigine (Lamictal) Stimulants Amphetamine salts (Adderall IR) Amphetamine salts (Adderall XR) Dextroamphetamine (Dexedrine) Lisdexamfetamine (Vyvanse) Caps/chews Amphetamine (Adzenys ODT) Amphetamine (Evekeo) Amphetamine (Dynavel XR) Dexmethylphenidate (Focalin IR) Dexmethylphenidate (Focalin XR) (Ritalin) mg mg 2000mg 6+ 2mg 500mg mg mg mg mg mg mg mg y: 2 20mg 5+ 30mg mg y: 2 20mg <50kg 60mg >50kg 100mg Seizures, aggression, bipolar Seizures, bipolar, aggression, agitation bipolar Hypotension, rash, raynaud s, wt loss, bradycardia, itching ER and sprinkles Headache, GI issues, somnolence, dizziness, tremor, liver function and platelets checked routinely Labs: CBC/BMP, liver & hepatic panel (baseline, 3mo, 6mo and as ) Stevens Johnson rash, GI issues, vertigo, headache, rhinitis other flu like symptoms ADHD ADHD ADHD ADHD ADHD Twice daily ADHD, parasomnia
4 (Ritalin SR & LA) (Metadate CD & ER) (Methylin) (Concerta) (Daytrana) patch (Quillivant XR & Quillichew) Non Stimulants Atomoxetine (Strattera) mg mg mg mg mg mg mg/kg child mg adol ADHD On AM ADHD Off PM Daily ADHD (6+) Increase blood pressure and heart rate, changes in mood, caution with liver concerns Clonidine mg 0.4mg ADHD (6+) Hypotension, sedation, somnolence (Kapvay) Guanfacine (Tenex) mg ADHD Hypotension, sedation, somnolence Guanfacine XR (Intuniv) mg Daily ADHD (6+) Hypotension, sedation, somnolence Antipsychotics Aripiprazole (Abilify) Asenapine (Saphris) mg Daily Schizophrenia 13+ Acute mania 10+ Irritability w/autism mg Bipolar mania and mixed QT prolongation, GI issues, weight gain, should not be swallowed whole, black cherry flavor, avoid eating/drinking for 10 min
5 Clozapine (Clozaril) Lurasidone (Latuda) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) mg 600mg Bipolar, schizophrenia, aggression Neutrophils, lab monitoring schedule, national registry required mg daily Schizophrenia, bipolar mg Daily Schizophrenia, bipolar I, mania/mixed mg mg Bipolar I 10+ Schizophrenia 13+ Irritability/autism Bipolar mania Schizophrenia Ziprasidone (Geodon) mg Schizophrenia, bipolar, aggression, irritability/autism
6 Paliperidone (Invega) Chlorpromazine (Thorazine) Haloperidol (Haldol) Pimozide (Orap) mg mg Up to 6x day mg mg Schizophrenia Short term for hyperactivity assoc with conduct disorders, psychotic disorders, acute agitation Schizophrenia 3+ Tourette s, disruptive behaviors 3+ Tourette s get EKG first, sedation, NMS risk Sedation, constipation, dry mouth, prolactinemia,
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All formulary medications available in generic form are supplied in generic form. Requests for brand name preparations must get prior authorization.
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PHARMACY COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 3/15/18 SECTION: DRUGS LAST REVIEW DATE: 3/15/18 LAST CRITERIA REVISION DATE: ARCHIVE DATE:
DYANAVEL XR (amphetamine) extended-release oral suspension Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit