This is the online version of the popular Clinical Handbook of
Psychotropic Drugs for Children and Adolescents, currently in its 5th print edition.
The Clinical Handbook of Psychotropic Drugs for
Children and Adolescents is
intended to be a user-friendly and practical resource guide for those who prescribe, dispense, and administer psychotropic drugs to children and
adolescents. Its content is derived from various forms of published literature (including randomized controlled
trials (RCTs), meta-analyses, scientific data such as pharmacokinetic trials, cohort trials, case series, and case reports) as well as
from leading clinical experts. We endeavor to continually update this handbook as the psychiatric literature evolves
so we can continue to provide evidence-based clinically relevant information that is easily accessed and utilized to
aid with patient care decisions. New sections, periodically added, reflect changes in therapy and in current
practice.
The purpose of this handbook is to provide quick access to relevant, practical, and important information
clinicians should be aware of when considering pharmacological options available in the treatment of childhood and
adolescent psychiatric disorders. It provides an overview of the plausible alternatives, dosing guidelines, as well
as information on drug interactions and potential side effects. It is meant to be a resource to both those in
training and experienced clinicians.
Most children and adolescents with a diagnosable psychiatric disorder require multimodal interventions to address the symptoms of
the disorder, the comorbid conditions, and the psychological, social, and developmental sequelae. Individual and
family psychoeducation are essential, and psychosocial interventions should be considered for most psychiatric
disorders before, or concurrently with pharmacotherapy.
While initially many classes of psychotropic drugs were used to treat childhood and adolescent mental illness on the basis of
efficacy in adults, much more published evidence has become available in this age group in recent years. The lack of regulatory approval in a country does not
necessarily reflect lack of safety or efficacy or controlled studies in these age
groups. While many product monographs include a statement that a drug has not been adequately studied in children
and/or the safety of the drug has not been established under a specific age, published RCT evidence supporting safety and efficacy may be available.
In the Product Availability section of each chapter, the Clinical Handbook includes
monograph statements regarding the recommendations for the use of each drug in children and adolescents. Approved
indications for children are stated, as are those for adults; also included are unapproved (also called off-label) indications
for these drugs. Each chapter includes data from open and double-blind studies, where available, regarding dosing,
adverse effects, monitoring, and other important considerations in children and adolescents.
Given that changes may occur in a medication's indications over time, and differences are seen among
countries, specific “indications” listed in this text as “approved” should be viewed in
conjunction with prescribing information/product monographs approved in your jurisdiction of interest.
Because of a lack of comparative data in children and adolescents for most drug classes, Adverse Reaction tables
and Drug Interaction charts reflect information that pertains to heterogeneous age groups (youth and adults).
Until systematic double-blind studies of various psychotropic drugs have been conducted to determine the
efficacy, the pharmacokinetics, as well as the relative and absolute risks of each drug in this population,
prescribers who choose to use specific psychotropic drugs in children and adolescents should review all available
studies and monitor their patients on a regular basis. Informed consent should be obtained from
the caregiver or youth (depending on the patient’s age) for medication use in both approved and unapproved
indications.
Dose comparisons and plasma levels are based on scientific data. However, it is important
to note that some patients will respond to doses outside the reported ranges. Age, sex, and
the medical condition of the child or adolescent must always be taken into consideration when prescribing
any psychotropic agent.
Patient and Caregiver Information Sheets for most drug categories are provided as printable pdf files to
facilitate education/counselling of patients receiving these medications and their caregivers. For details, please
see “Patient and Caregiver Information Sheets”.
Instantly recognizable icons and color coding,
search and browse features, charts and column-selector enhanced tables of comparisons are
employed to enable the reader to have quick access to information.
Over the years, readers have asked many interesting questions and provided useful
comments and suggestions regarding the content and format of the handbook. This input is
critical to keeping this handbook current, accurate, and relevant to the readership. We
appreciate readers' feedback, so we invite you to send e-mail to the address below with your comments
and questions.
Dean Elbe
E-mail: DElbe@cw.bc.ca