A 15-day titration is usually the most economical and convenient way to identify the optimal dose of attention-deficit/hyperactivity disorder medications.
Starting children on a low dose and waiting up to a month before reassessing wastes time and money, Dr. James J. McGough said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent Psychiatry.
“You don’t need a month at a low dose to see what’s happening,” said Dr. McGough, chief of staff of the Resnick Neuropsychiatric Hospital at the University of California, Los Angeles. “You generally need 5-7 days on a dose to assess any response. Any less than that and you might have a random good day or a random bad day. You want enough behaviors to see what’s really going on and to get a little bit of tolerance to any side effects.”
Dr. McGough backs a more rapid titration schedule than that typically recommended by the Food and Drug Administration for most ADHD medications. The schedule stays within the limits imposed by the Drug Enforcement Administration, while expediently getting children to an effective dose.
After an assessment and drug selection, he writes an initial prescription for a month’s worth of the drug. Parents receive a titration schedule. A typical schedule calls for starting with one pill for 5 days, two for the next 5 days, and three for the last 5 days, with a follow-up appointment around 2-3 weeks.
“This takes children through the dose range and lets you see how they respond to each dose. I try them over a reasonable range of dose and when they find one that works, I try it for 1 month. If it’s successful, I give them 3 months of medication, which I’m allowed to do in my state.”
Education is important for parents and children. But Dr. McGough tells families not to worry too much about any mild treatment-related side effects. “I tell them there might be a little stomach ache or headache, but that we’ll address this in just a couple of weeks. The real message is that you don’t want to waste your time or the patients’ time.”
Dr. McGough disclosed that he is on the advisory boards of NextWave Pharmaceuticals, Noven Pharmaceuticals, Shiongi & Co., Shire Pharamceuticals Inc., and Supernus Pharmaceuticals, and is a consultant for Alexa Pharmaceuticals and Medimmune.