Time to Stable Dose of Psychostimulants in Pediatric Patients With ADHD

OBJECTIVES The prevalence of attention-deficit/hyperactivity disorder (ADHD) is increasing and psychostimulants are the pharmacological standard of care. Patients benefit most when there is efficient titration to a stable dose of medication as defined by maintaining that same dose for 6 months. The aims of this study were to describe time to stable dose in a cohort of children with ADHD and examine the impact of demographic factors. METHODS A list of pediatric patients with a diagnosis of ADHD in the electronic health record was generated, and a retrospective chart review of stimulant use was conducted on 500 patients randomly selected from 2010 to 2015 who met inclusion criteria. Time to stable dosing and its association with demographic characteristics were assessed. RESULTS Patients were predominantly male (72%), white (81%), and privately insured (67%). Fifty-five percent of patients achieved a stable dose of medication on first attempt; therefore, the median time to stable dosing for the cohort was 0 days with the interquartile range being 0 to 133.8 days. There was significant increase in time to stable dose for patients younger than 10 years compared with those ≥10 years of age (p = 0.01). Time to stable dose was not significantly associated with race (p = 0.13), sex (p = 0.72), type of insurance (p = 0.56), or formulation being immediate or extended release (p = 0.56). CONCLUSIONS Many patients had long titration periods when trying to reach a stable dose. Given that medication switching can be challenging for patients and families, more frequent contact with providers during titration may be necessary.

Management of antipsychotic-induced hyperprolactinaemia

SummaryHyperprolactinaemia is a common endocrine disorder that can be associated with significant morbidity. Antipsychotic medications are frequently linked to hyperprolactinaemia. This disorder usually presents as menstrual problems in women and sexual problems in men, which affect the patients' quality of life and adherence to antipsychotic treatment. In the past, treatment for hyperprolactinaemia was recommended only for symptomatic patients. However, it has become clear that persistent asymptomatic hyperprolactinaemia can be associated with long-term physical morbidities such as osteoporosis and possibly breast cancer. Hence, it is imperative that hyperprolactinaemia is managed even if asymptomatic when initially detected. This article discusses the various management options, such as reducing the dose of antipsychotic medication, switching to a prolactin-sparing antipsychotic and adding aripiprazole to the treatment regimen.Learning Objectives• Understand the physiology of the prolactin hormone• Be able to judge when to intervene if a patient on an antipsychotic medication presents with hyperprolactinaemia• Learn about the different treatment options