ADHD is a very common psychiatric disorder in childhood. Children with ADHD have frequently another psychiatric disorder. Conduct disorder, learning disorder, addiction, and mood disorders are frequently seen in children with ADHD. It has been estimated that 23%-42% of youth receiving psychiatric drugs are receiving multiple drugs (1). Recently drug interactions have been emphasized in these patients. Stimulant drugs and atomoxetine, which is a non stimulant drug, are used in patients with ADHD. Interactions between these drugs and other psychotropic drugs are important for treatment quality. Drug interactions should be considered to prevent adverse effects and increase treatment quality. Possible drug interactions could impact on liver, intestine, or plasma. There are a lot of important risks due to drug interactions in patients with ADHD. Drug plasma levels can change due to CYP-P450 system interactions. It is estimated that approximately 7% of the population may be poor metabolizers, causing slow metabolism(2). Also inhibitors of the cytochrome P450 can increase drug levels by several folds. Some drugs inhibit these systems very potently so that concentration of drug can reach very high levels. Important complications such as neuroleptic malignnant syndrome, serotonergic syndrome, and hallucinations can be seen during these interactions. Treatment strategies should be reviewed from this perspective. Possible drug interactions couldn't be exactly predicted by the clinicians for every patient. But potential drug interactions should be considered for every patient. Drug interactions will be discussed at this presentation. The treatment strategies will be updated for long term good quality treatment based on the literature.
References:
1. McIntyre RS, Jerrell JM. Polypharmacy in children and adolescents treated for major depressive disoerder: a claims database study. Journal of clinical psychiatry.2009;70(2):24-46.
2. Barton J: Atomoxetin: a new pharmacotherapeutic approach in the managment of ADHD, Archives of disease in childhood 2005;1(90):26-29.