She occasionally wakes up in the middle of the night to shower as well. When she comes in for her well-child check she has red, chapped skin on both hands, and she acknowledges that she washes her hands “a lot.” Her mother reports that she spends a total of 2 hours each afternoon, after she comes home from school, washing her hands because she believes her desk at school is “covered in germs.”
Which medication is approved by the United States Food and Drug Administration (FDA) to treat these symptoms for a 6-year-old patient?
- Fluoxetine (Prozac©)
- Paroxetine (Paxil©)
- Fluvoxamine (Luvox©)
- Sertraline (Zoloft©)
- Clomipramine (Anafranil©)
Answer: D
Rudolph’s Pediatrics, 23rd Edition, Self-Assessment and Board Review,
Copyright © 2023 by McGraw Hill LLC.
Reference: p.404, 407, Section 7, Pediatric Mental Health, Rudolph’s Pediatrics, 23rd Edition.
The symptoms described are those of obsessive-compulsive disorder. There a number of medications approved by the FDA for treatment of these symptoms; of those listed above, only paroxetine is not approved for this use. The distinguishing characteristic (in addition to side effect profile) to consider when selecting a medication is the age for which FDA approval has been given (Table 93-4). Only sertraline has been approved to treat children as young as 6 years old.
TABLE 93-4 MEDICATIONS APPROVED FOR ANXIETY DISORDERS IN CHILDREN AND ADOLESCENTS
|
Generic Name (Brand Name) |
Subclass |
Dosing |
FDA-Approved Uses |
Ages |
Additional Information |
|
Fluoxetine (Prozac) |
SSRI |
20–60 mg/d Start 10 mg/d, increase to 20 mg/d on day 14 |
OCD |
7 y and older |
Long half-life (4–6 d) Available in liquid form |
|
Sertraline (Zoloft) |
SSRI |
25–200 mg/d Start at 25 mg/d and increase to 50 mg after 7 days; increase to 50 mg and then may increase every 4 weeks |
OCD |
6 y and older |
Available in liquid form |
|
Fluvoxamine (Luvox) |
SSRI |
50–200 mg/d Oral daily dosing to twice/day Start 25 mg at bedtime, increase by 25 mg/d q4–7 d; maximum dose is 200 mg/d up to 11 y, 300 mg/d for > 11 y |
OCD |
8 y and older |
|
|
Duloxetine (Cymbalta) |
SNRI |
30–60 mg/d Start 30 mg/d; may increase by 30 mg/d after 2 weeks |
GAD |
7 y and older |
Used for treatment of neuropathic pain in adults |
|
Clomipramine (Anafranil) |
TCA |
100–200 mg at bedtime Start 25 mg qd, increase by 25 mg/d q4–7 days; maximum 3 mg/kg/d up to 100 mg/d in first 2 wk and up to 200 mg/d maintainance |
OCD |
10 y and older |
GAD, generalized anxiety disorder; OCD, obsessive-compulsive disorder; q4–7, every 4 to 7; qd, once daily; SNRI, serotonin norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.
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