Daytrana is helpful for kids who, for whatever reason, cannot use any of the wide variety of oral stimulant preparations. Otherwise, we don’t recommend it due to high cost, lag time for onset of effect, and the side effect of rash, which is pretty common and unpleasant. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Like the first norepinephrine reuptake inhibitor for ADHD, atomoxetine, viloxazine has no misuse potential and is less likely than stimulants to cause insomnia, anxiety, or tics. However, it is generally less effective than stimulants and takes longer to work. While viloxazine may work faster than atomoxetine, it’s unclear if it has any advantage, and unlike atomoxetine, there’s no option for a cheaper generic. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Vyvanse may have a gentler, “smoother” side effect profile than other amphetamines, and probably has a lower risk of diversion or misuse. However, its high cost means insurance companies don’t like to pay for it without prior authorizations. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

The combination product is preferred over buprenorphine alone for maintenance because the addition of naloxone affords it a lower potential for injection misuse. The SL film formulation is priced a little higher than the SL tablets, yet provides very little (if any) meaningful benefits; generic SL tablets should be used as a cost-saving measure. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Highly addictive substance; its use is generally not recommended. Watch the television show Breaking Bad if you’re not convinced! From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Despite the lack of large randomized controlled data to support first-line use, buspirone may be used adjunctively in kids who exhibit partial response to first-line therapies for anxiety (SSRI, SNRI), without the sedation and abuse potential burden of benzodiazepines. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Antihistamines can be effective sleepers for some kids and are the most prescribed by pediatricians, although some patients may experience too much grogginess (“hangover”) in the morning or a paradoxical excitation. Good option to keep in your bag of tricks due to experience in kids and low risk of tolerance, dependence, or abuse. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

A patch option in the amphetamine class of stimulants for kids who cannot use the wide array of oral stimulants available today. Minimal data and less experience than with methylphenidate transdermal (Daytrana), but similar to Daytrana in terms of high cost, lag time for onset of effect, and side effects. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Haloperidol is an effective, inexpensive first-generation antipsychotic with a long history of experience and use even in kids, but clinical utility is limited due to potential for EPS, prolactin elevation, and TD. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Although clinicians often try other medications first due to both the relative complexity of managing lithium as well as bias from the public, lithium, along with several second-generation antipsychotics, is FDA indicated and considered first line for treating pediatric bipolar disorder. Although it is not free from side effects, most common effects can be managed quite well. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).