99 The dosage of haloperidol ranged from 0.02 to 0.12 mg/kg/day, or 0.5 to 3.5 mg/day. As expected, EPSs and sedation were the most problematic AEs. Atypical neuroleptics Clozapine proved superior to haloperidol for treating positive and negative psychotic symptoms in a doubleblind, 6-week study of 21 adolescents with schizophrenia.100 As with prior adult studies of clozapine, AEls of concern included seizures and neutropenia. Several open studies of clozapine in COS also demonstrated neutropenia, as well as other AEs, such as sedation and drooling.101 A review Inhibitors,research,lifescience,medical of 15 studies of clozapine in COS, including controlled and open data,102 suggested that clozapine had a greater antipsychotic effect than Inhibitors,research,lifescience,medical typical antipsychotics

during acute episodes, more improvement in chronic forms of the illness with FK228 supplier prominent negative symptoms, and “good tolerability” with fewer reports of EPS. In another review of atypical neuroleptics (including clozapine, risperidone, olanzapine, sulpiride, tiapride, amisulpride, remoxipride, and clothiapine) for COS,103 clozapine seemed to have the most robust effect on the symptoms of COS, and risperidone and olanzapine also had utility in the treatment of COS. Overall, clozapine remains a tertiary treatment option for COS due to its association

with potentially Inhibitors,research,lifescience,medical dangerous AEs, including agranulocytosis, seizures, tachycardia, and arrhythmia. Risperidone Inhibitors,research,lifescience,medical has proven useful in the treatment of a number of pediatric disorders,

but no controlled treatment study of risperidone has been performed for COS. Open studies of risperidone (up to 10 mg/day) have been promising for adolescents and children and adolescents with COS based on the CGI-I, BPRS, and KPANSS.104,105 In both studies, the AEs included sedation and EPS. In a controlled study of risperidone for adults with first-onset schizophrenia, doses of 2 to 4 mg/day were superior to 5 to 8 mg/day. By extrapolation, the open studies of pediatric patients described above likely utilized too high a dose of risperidone. The only published Inhibitors,research,lifescience,medical controlled data on risperidone use in pediatric subjects is a treatment study of adolescents with conduct disorder.106 Weight gain has been the most problematic AE in two open-label studies of risperidone treatment of children and adolescents with aggression and other psychiatric problems.107,108 There have been Adenosine no published controlled studies of olanzapine in COS. Open-label studies of olanzapine for COS indicate a positive impact on psychotic symptoms,109-111 and report primary AEs including weight gain, sedation, and akathisia, ie, a profile similar to that reported in adults. A pharmacokinetic study suggested similar olanzapine exposure (defined as area under the concentration-time curve) in children and adolescents with COS compared with adults.112 The authors suggested that 10 mg/day olanzapine is the target dose for treating psychosis in pediatric patients, consistent with dosing in adults.