Agent | Initial daily dose | Suggested dose titration based upon response | Maintenance daily dose range | Selected characteristics*¶ |
SSRIs* | ||||
FluoxetineΔ | Children: 5 to 10 mg Adolescents: 10 to 20 mg | Increase daily dose by 5 to 10 mg (child) or 10 to 20 mg (adolescent) after 14 days or more | Pre-adolescent: 20 to 30 mg Adolescent: 20 to 60 mg |
|
FluvoxamineΔ | Children: 12.5 to 25 mg Adolescents: 25 to 50 mg | Increase daily dose by 25 mg (child) or 25 to 50 mg (adolescent) after 7 days or more | Pre-adolescent: 50 to 200 mg Adolescent: 50 to 300 mg |
|
SertralineΔ | Children: 12.5 to 25 mg Adolescents: 25 to 50 mg | Increase daily dose by 25 (child) or 50 mg (adolescent) after 7 days or more | 25 to 200 mg |
|
SSRI – potential alternate* | ||||
Paroxetine | Children age ≥7 years: 5 mg Adolescents: 10 mg | Increase daily dose by 10 mg after 7 to 14 days or more | 10 to 60 mg |
|
TCA | ||||
ClomipramineΔ | Children ≥10 years and adolescents: 25 mg | Increase daily dose by 25 mg every 7 to 14 days or more | 25 to 200 mg Maximum: smaller of 200 mg or 3 mg/kg per day◊ |
|
SGAs for SSRI augmentation | ||||
Risperidone | 0.25 mg | Increase daily dose by 0.25 mg after 7 to 14 days or more | Maximum: 1.5 to 2 mg |
|
CYP: cytochrome P450; ECG: electrocardiogram; OCD: obsessive-compulsive disorder; P-gp: P-glycoprotein; SGA: second-generation antipsychotic; SSRI: selective serotonin reuptake inhibitor; TCA: tricyclic antidepressant.
* Common generally mild adverse effects of SSRIs seen in children treated for various anxiety disorders may include headache, anorexia, vomiting, sleep disturbance, and somnolence.
¶ This table notes when agents are moderate or strong inhibitors of CYP isoenzymes as well as when agents are major substrates of CYP isoenzymes or P-gp. Significant interactions can occasionally occur due to weak inhibition of CYP isoenzymes (eg, target drug is highly dependent on CYP metabolism and has a narrow therapeutic index). Accordingly, specific interactions should be checked using a drug interactions program.
Δ Sertraline, fluoxetine, and fluvoxamine are approved for treatment of OCD in children age ≥6, 7, and 8 years respectively in the United States. Clomipramine is approved for treatment of OCD in children age ≥10 years in the United States.
◊ Dose-related ECG changes have been reported in children and close monitoring is necessary with larger doses. According to the product information approved in the United States, doses >2.5 mg/kg per day are not recommended in children.