Judges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children
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1 Judges Reference Table for the Psychotropic Medication Utilization Parameters for Foster Children Stimulants for treatment of ADHD Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages years) Amphetamine mixed salts Adderall Approved for children 3 years and 40 mg/day Evekeo Adderall XR 30 mg/day Adzenys XR-ODT (oral disintegrating tablet) Ages 6-12 years: 18.8 mg/day Ages years: 12.5 mg/day See note* 18.8 mg 12.5 mg Amphetamine base Dyanavel XR (oral suspension) 20 mg/day See note* 20 mg 20 mg Dextroamphetamine Dexedrine Approved for children 3 years and Dextroamphetamine Zenzedi 40 mg/day Approved for children 3 years and 40 mg/day Dextroamphetamine Procentra (oral suspension) Approved for children 3 years and 40 mg/day Dextroamphetamine Dexedrine Spansule Age 6 years: 40 mg/day
2 Judges Reference Table for Parameters 2 Stimulants for treatment of ADHD (continued) Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages years) Ritalin Methylin (chewable and oral suspension) Ritalin SR Methylin ER Metadate ER Ritalin LA Methylphenidate Metadate CD Quillivant XR (oral suspension) QuilliChew ER (chewable) Aptensio XR Concerta 54 mg/day lesser of 72 mg/ day or 2 mg/kg/day, whichever is less 36 mg 108 mg 108 mg Daytrana TD patch 30 mg/day 20 mg 30 mg 30 mg Focalin 20 mg/day 10 mg 50 mg 50 mg Dexmethylphenidate Focalin XR 30 mg/day 10 mg 50 mg 50 mg
3 Judges Reference Table for Parameters 3 Other ADHD Treatments Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages years) Atomoxetine Strattera ADHD (age 6-17 years): 1.4 mg/kg/day or 100 mg/day, whichever is less 1.8 mg/kg/day or 100mg 1.8 mg/kg/day or 100mg Catapres (IR) Not approved for treatment of ADHD in children and 0.4 mg 0.4 mg Clonidine Kapvay (ER) Approved for monotherapy and adjunctive therapy to stimulants for treatment of ADHD (age 6-17 years): 0.4 mg/day 0.4 mg 0.4 mg Tenex (IR) 4 mg 4 mg Guanfacine Intuniv (ER) Approved for monotherapy and adjunctive therapy to stimulants for treatment of ADHD 4 mg 7 mg 4 mg/day 7 mg/day Bupropion Wellbutrin 6 mg/kg/day or 300 mg 6 mg/kg/day or 300 mg Wellbutrin SR 400 mg 400 mg Wellbutrin XL 450 mg 450 mg enuresis in children Imipramine Tofranil Age 6-11 years: 2.5 mg/kg/day or 50 mg/day, whichever is less Age 12 years: 2.5 mg/kg/day or 75 mg/day, whichever is less 4 mg/kg/day or 200mg 4 mg/kg/day or 200 mg depression 12 years: 100 mg/day Aventyl Nortriptyline Pamelor 2 mg/kg/day or 100 mg 2 mg/kg/day or 100 mg Nortrilen
4 Judges Reference Table for Parameters 4 Antidepressants, SSRIs Citalopram Celexa Age 6-11 years: 40 mg Age years: 40 mg Escitalopram Lexapro MDD in (age years): 20 mg/day Age 6-11 years: 20 mg Age years: 30 mg Fluoxetine Prozac MDD (age 8-18 years): 20 mg/day OCD (age 7-17 years): Age 6-11 years: 60 mg Age years: 60 mg Paroxetine Paxil Age years: 40 mg Paxil CR Age years: 50 mg Luvox OCD (age 8-17 years): Fluvoxamine Luvox CR Ages 8-11 years: 200 mg/day Ages years: 300 mg/ day Age 8-11 years: 200 mg Age years: 300 mg Sertraline Zoloft OCD (age 6-17 years): 200 mg/day Age 6-11 years: 200 mg Age years: 200 mg Vilazodone Viibryd
5 Judges Reference Table for Parameters 5 Antidepressants, SNRIs Venlafaxine Effexor Effexor XR and Age 7-11 years: 150 mg Age years: 375 mg Duloxetine Cymbalta Generalized Anxiety Disorder Age 7-17 years: 120 mg/day Age 7-11 years: 120 mg Age years: 120 mg Desvenlafaxine Pristiq and Age years: 100 mg Levomilnacipram Fetzima and Clomipramine Anafranil OCD: Age years: 3 mg/kg/day or 200 mg/ day, whichever is less Age years: 200 mg Age years: 200 mg Antidepressants, Other Mechanisms Mirtazapine Remeron and Age 3-5 years: 45 mg Age 6-11 years: 45 mg Age years: 45 mg Vortioxetine Trintellix and
6 Judges Reference Table for Parameters 6 Antipsychotics: Second Generation (Atypical) Aripiprazole Quetiapine Abilify Abilify Discmelt (oral disintegratng tab) Abilify (oral solution Seroquel Seroquel XR Bipolar Mania or Mixed Episodes (age years) and Schizophrenia (13-17 years): 30 mg/day irritability associated with Autistic Disorder (age 6-17 years): 15 mg/day Bipolar Mania (age years): 600 mg/day Schizophrenia (13-17 years): 800 mg/day Age 4-5 years: 15 mg Age 6-11 years: 15 mg Age years: 30 mg Age 6-9 years: 400mg Age 5 years: 400 mg Age years: 800 mg Age years: 800 mg Olanzapine Zyprexa Zyprexa Zydis Bipolar Mania or Mixed Episodes and Schizophrenia (age years): 20 mg/day Age 4-5 years: 12.5 mg Age 6-11 years: 20 mg Age years: 20 mg Risperidone Risperdal Risperdal M-Tab (oral disintegrating tab) Risperdal (oral solution) Schizophrenia (age years) and Bipolar Mania or Mixed Episodes (age years): 6mg/day irritability associated with autistic disorder (age 5-16 years): 3 mg/day Age 4-5 years: 3 mg Age 6-11 years: 3 mg Age years: 6 mg Clozaril Clozapine FazaClo (oral disintegrating tablet) Age 8-11 years: 300 mg Age years: 600 mg Versacloz oral suspension Asenapine Saphris (sublingual tablet) Approved for acute treatment of Bipolar Mania and Mixed Episodes (age years): 10 mg twice daily Age years: 20 mg Age years: 20 mg Iloperidone Fanapt Paliperidone Invega Schizophrenia (age years): Weight < 51 kg: 6 mg/day Weight 51 kg: 12 mg/day Age years: 12 mg Ziprasidone Geodon Age years: 80 mg Age years: 160 mg Lurasidone Latuda Brexpiprazole Rexulti
7 Judges Reference Table for Parameters 7 Antipsychotics: First Generation (Typical) severe behavioral problems (age 6 months-12 years) Chlorpromazine Thorazine Outpatient Children: 0.55 mg/kg every 4-6 hours, as needed Inpatient Children: 500 mg/ day Age 3-5 years: 40 mg 75 mg 800 mg Approved for the management of manifestations of Psychotic Disorders (age > 12 years): 1000 mg/day Approved for treatment of Psychotic Disorders, Tourette s Disorder, and severe behavioral problems (age 3 years): Haloperidol Haldol Psychosis: 0.15 mg/kg/day Age 3-5 years: 3 mg 6 mg Ages years: 15 mg Tourette s Disorder and severe behavioral problems: mg/kg/day Severely disturbed children: 6 mg/day Perphenazine Trilafon psychotic disorders (age 12 years): Outpatient: 24 mg/day 64 mg Inpatient: 64 mg/day Pimozide Orap Tourette s Disorder (age 12 years): Age 7-12 years: 6 mg 10 mg 10 mg/day or 0.2 mg/kg/ day, whichever is less
8 Judges Reference Table for Parameters 8 Mood Stabilizers Carbamazepine Divalproex Sodium Lithium Epitol (tab) Tegretol (tab, oral suspension, chewable) Tegretol XR (tab) Carbatrol (extended release capsule) Equetro (extended release capsule) Depakote delayed- release tablets Depakote ER extendedrelease tablets Depakote sprinkles Seizure Disorders in all ages Age < 6 years: 35 mg/kg/day Age 6-15 years: 1000 mg/day Age >15 years: 1200 mg/day Seizure Disorders (age 10 years) Maximum dose based upon serum level: µg/ml, or 60 mg/kg/day Age 4-5 years: 35 mg/kg/day 800 mg 1000 mg Age years: 1200 mg Eskalith Eskalith CR manic episodes and maintenance of Bipolar Disorder (age 12 years) Maximum dose based upon 12 hour post dose serum level: 1.2 meq/l Lithobid ER Serum level- 125 µg/ml or 60 mg/kg/day Serum level- 125 µg/ml or 60 mg/kg/day Approved for adjunctive therapy for Seizure Disorders: Lamotrigine Lamictal Age 2-12: 400 mg/ day Age >12: 500 mg/day (use > 200mg/day in adults for bipolar depression has not conferred additional efficacy) 15 mg/kg/day or 500 mg/day 15 mg/kg/day or 500 mg/day Safety and effectiveness for treatment of Bipolar Disorder in patients younger than 18 years had not been established Oxcarbazepine Trileptal Seizure Disorders as mono- therapy (age 4 years), or as adjunctive therapy in (age 2 years): 60 mg/kg/day or 1800 mg/day Age 7-12 years: 60 mg/kg/day or 1500 mg 60 mg/kg/day or 2100 mg Safety and effectiveness for treatment of Bipolar Disorder in patients younger than 18 years had not been established
9 Judges Reference Table for Parameters 9 Sedatives/Hypnotics Diphenhydramine Benadryl insomnia (age 12 years): 50 mg at bedtime Age 3-5 years: 12.5 mg 25 mg 50 mg Trazodone Desyrel or as a hypnotic 100 mg Eszopiclone Lunesta or Melatonin No brand name Regulated by FDA as a dietary supplement and not as a medication (no FDA approved indications) Age 3-5 years: 3 mg 6 mg 6 mg Ramelteon Rozerem or anxiety and tension: Hydroxyzine Vistaril Age <6 years: 50 mg/day in divided doses Age = 6 years: mg/day in divided doses Age 3-5 years: 25 mg Age 6-11 years: 50 mg Age years: 100 mg Approved as a sedative when used as a premedication and following general anesthesia: 0.6 mg/kg The full report of the Psychotropic Medication Utilization Parameters for Children and Youth in Foster Care can be found at:
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