Risperidone offers more efficacy and safety data in kids than other antipsychotics and is often used first-line in autistic kids, but you need to expect and monitor for EPS, prolactinemia, and weight gain. Consider co-administration with benztropine to prevent EPS and/or metformin to prevent weight gain. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Compared to carbamazepine, oxcarbazepine poses less concern for drug interactions and for hepatic or hematologic toxicities; it also does not require serum level monitoring. However, due to lack of efficacy data in pediatric bipolar disorder, we do not recommend its general use for that disorder. Still, some clinicians use oxcarbazepine to try to reduce irritability in a wider range of clinical circumstances. It is reserved for third-line use after lithium and valproic acid, and even after carbamazepine. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Benzodiazepines are generally only appropriate for use before procedures. Lorazepam probably has less risk of misuse than others. Lorazepam is also the first-line, but off-label, treatment for catatonia. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

St. John’s wort can be considered an option for short-term treatment of mild depression in adults, but for kids the evidence is weaker. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Not a first-line treatment for bipolar disorder in kids due to limited data, side effect profile, and high likelihood of significant interactions. Used in kids for seizure disorders, so we have some basis of safety information. Equetro is FDA approved for bipolar disorder (in adults), but other cheaper formulations give similar results. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Opioid replacement therapy via methadone reduces or eliminates illicit use of opioids and criminality associated with opioid use, supporting health and social functioning. It is a harm reduction model reducing transmission of infectious diseases such as hepatitis and HIV. Disadvantages include potential for accumulation with repeated doses (which may result in toxicity), interindividual variability in pharmacokinetic parameters, potential for drug interactions, challenges associated with dose titration, stigma associated with opioid replacement therapy, and limited availability of treatment programs (nonexistent in some geographic areas, long wait lists in other areas). Methadone has long been established as an effective treatment of opioid addiction in adults, although federal regulations prohibit most methadone programs from admitting patients younger than 18 years. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Buprenorphine alone was previously preferred for initial (induction) phase of treatment, with buprenorphine/naloxone combination preferred for maintenance treatment (unsupervised administration). Currently, combination is favored for both induction and maintenance as this decreases misuse or diversion potential. Studied and approved for ages ≥16. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Well-tolerated and inexpensive alternative to second-generation antipsychotics, especially when trying to avoid EPS and metabolic side effects; however, efficacy data in kids are more limited compared to newer agents. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

There are many longer-acting methylphenidate preparations. Two good options are Concerta and Ritalin LA, available as generics. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Good drug with very long history of experience, available in short- and long-acting formulations as generics. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).