Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials

Table 1 Key points for pharmacotherapy in autism spectrum disorders

ADHD medications	Antipsychotic medications	Anti-seizure medications
Stimulants for high-functioning ASD: (1) Methylphenidate in young children; and (2) Dextroamphetamine immediate release in children, adolescents and adults is often useful	Risperidone: Especially useful for self-injurious behavior: Also useful in children for irritability and aggression in low, divided doses	Phenytoin and phenobarbital frequently worsen behavior. Replace with newer medications in consultation with neurologist
Non-stimulants for lower-functioning ASD: (1) Atomoxetine; (2) Amitriptyline; and (3) Guanfacine in low, divided doses if tics/Tourette disorder	Loxapine at 5-10 mg/day: Useful in adolescents and adults for irritability, aggression, or with risperidone as a weight-sparing strategy	Levotiracetam, carbamazepine, benzodiazepines, and others may also adversely affect behavior
For greater effect: Low-dose combination of stimulant and non-stimulant medications may be tried	Watch out for the following, especially with high-dose antipsychotics: Difficulty in swallowing or bowel obstructions in more severely disabled individuals	Gabapentin may be useful as an add-on to divalproex for bipolar disorder, instead of lithium

Selective serotonin reuptake inhibitors may reduce anxiety or depression in high-functioning individuals but are unlikely to alleviate repe-titive/compulsive behaviors in autism spectrum disorders, and often cause activation and behavioral worsening. ASD: Autism spectrum disorders; ADHD: Attention deficit hyperactivity disorder.