Autism Medications Cheat Sheet

It can be difficult to keep all the different medications for autism straight!  Below, we summarized some of the most commonly prescribed medications for autistic people, what their side effects are, and other relevant information.

Important Points About Each Medication

For each medication that we discuss, we will address each of the following point:

Generic Name: The active ingredient in a medication that makes it work

Brand Name: The name that a pharmaceutical company gives a medication

Class: Medications are sorted into different categories depending on their chemical structures, how they work, and what they treat.

Treats: The symptoms that each medication has been known to treat in autism

Side Effects:  A side effect is an outcome caused by taking a medication that is other than the intended outcome.  Side effects can range in their severity and it’s important to remember that they vary from person to person.  When using a medication, you and your doctor will need to determine whether a given side effect is tolerable and how it might be managed.

Contraindications: It can be dangerous to take certain medications if you or your child has certain conditions or is using certain substances.  Contraindications are essentially a list of instances in which a certain medication should not be used.  For example, certain medications, such as tetracyclines, are contraindicated for pregnant women because they can cause babies to be born with birth defects and cause liver toxicity in mothers.  Your prescribing doctor and pharmacist should check for contraindications before prescribing a given medication, but it’s important for consumers to be aware of them too.

Black Box Warning: A Black Box Warning (also known as a “Box Warning”) is something that is placed on a medication’s outer packaging when the FDA has determined that the medication has serious side effects.  Black box warnings don’t mean that you shouldn’t use a medication, only that you need to be careful about how you use it.  Make sure you discuss medication side-effects with you or your child’s doctor and report any side-effects you or your child experience.

Notes: Helpful or important details about a given medication.

 

Medications

Generic Name: Amitriptyline

Brand Name:  Elavil, Vanatrip

Category: Tricyclic

Autism Symptoms Treated: Impulsivity, hyperactivity

Side Effects: Drowsiness, difficulty concentrating, hallucinations, confusion, dry mouth, blurred vision, urinary retention

Contraindications:  Using cisapride (also known as Prepulsid or Propulsid), On-going use of an MAOI or use of an MAOI within the last 14 days, hypersensitivity to amitriptyline, in recovery from myocardial infarction (heart attack)

Black Box Warning: Yes – “Increased risk of suicidality, particularly in people under 24 years old. Not approved for pediatric use.”

 

Generic Name: Amphetamine Salts

Brand Name:  Adderall

Category: Stimulant

Autism Symptoms Treated: Attention deficit hyperactivity disorder

Side Effects:  Insomnia, nervousness, dizziness, restlessness, tics, weight loss, reduced appetite, nausea, dry mouth, and addiction

Contraindications:  On-going use of an MAOI or use of an MAOI within the last 14 days, agitation, hypersensitivity to amphetamine, agitation, arteriosclerosis, cardiovascular disease, history of drug abuse, hypertension, hyperthyroidism

Black Box Warning: Yes – “Amphetamines have a high potential for abuse and dependence. Access to drug supply should be limited as there is a potential for non-therapeutic use or distribution to others. Misuse of amphetamines may cause sudden death and serious cardiovascular adverse reactions.”

 

Generic Name: Aripiprazole

Brand Name:  Abilify

Category: Antipsychotic

Autism Symptoms Treated: Psychomotor agitation (restlessness, anxiety, and/or unintentional movements)

Side Effects: Common: headache, agitation, insomnia, anxiety, extrapyramidal symptoms, akathisia, sedation, weight gain, nausea, constipation, vomiting, dyspepsia.  Less Frequent: dizziness, pyrexia, restlessness, fatigue, lethargy, lightheadedness, pain , dystonia, hypersomnia, irritability, impaired coordination, suicidal ideation, orthostatic hypotension, tachycardia, chest pain, hypertension, peripheral edema, rash, hyperhidrosis, increased salvation, decreased appetite, increased appetite, xerostomia, toothache, abdominal pain, diarrhea, weight gain, tremor, extremity pain, stiffness, myagias, spasm, athralgias, dyskinesia, increased creatine phosphokinase, weakness, nasopharyngitis, pharyngolaryngeal pain, cough, rhinorrhea

Contraindications: Hypersensitivity to aripiprazole

Black Box Warning: Yes – “Increased risk of death in elderly patients with dementia related psychosis. Increased risk of suicidal thinking and behaviors in children and young adults under the age of 24.”

Notes: FDA Approved for treating autism

 

Generic Name: Carbamazepine

Brand Name:  Tegretol, Carbatrol, Epitol, Equetro, Carnexiv

Category: Anticonvulsant

Autism Symptoms Treated: Seizures, agitation

Side Effects: Hypersensitivity reactions, dystonic reactions, rashes, exacerbation/development of cardiac dysrhythmias, cytopenias, transaminitis, pancreatitis, mild toxicity with chronic use

Contraindications: Bone marrow depression, on-going use of an MAOI / use of an MOAI within the last 14 days, on-going use of boceprevir, on-going use of nefazodone, on-going use of delavirdine, hypersensitivity to carbamazepine or tricyclics

Black Box Warning: Yes – “Carbamazepine has been reported to be associated with aplastic anemia and agranulocytosis. In addition, Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported, especially with HLA-B*1502 allele.”

 

Generic Name: Citalopram

Brand Name:  Celexa

Category: SSRI, used as Anti-anxiety medication in autism

Autism Symptoms Treated: Anxiety, obsessive compulsive disorder

Side Effects:  Common: nausea, vomiting, dry mouth, drowsiness, insomnia, sweating, tremor, diarrhea, upset stomach, anxiety, weakness/lack of energy, muscle aches and pains, rash, weight gain.  Severe:  suicidality, worsening depression, serotonin syndrome, mania, seizures, elevated liver enzymes, low blood sodium levels, SIADH, hypoglycemia, tachycardia, hepatitis, withdrawal.

Contraindications: On-going use of an MAOI or use of an MAOI within the last 14 days, on-going use of pimozide, hypersensitivity to citalopram

Black Box Warning: Yes – “Increased risk of suicidality, particularly in people under 24 years old. Not approved for pediatric use.”

Notes:  King et al., 2009 (please see references) did not find any significant changes in certain symptoms of autism in children when treated with citalopram.

 

Generic Name: Clomipramine

Brand Name:  Anafranil

Category: Tricyclic

Autism Symptoms Treated:  Obsessive compulsive disorder, insomnia, inability to remain still, other autism symptoms

Side Effects: Drowsiness, difficulty concentrating, hallucinations, dry mouth, blurred vision, urinary retention.

Contraindications: On-going use of an MAOI or use of an MAOI within the last 14 days, recovering from myocardial infarction, hypersensitivity to clomipramine, recent myocardial infarction (heart attack)

Black Box Warning: Yes – “Increased risk of suicidality, particularly in people under 24 years old. Not approved for pediatric use.”

 

Generic Name: Clonazepam

Brand Name:  Klonopin

Category: Anticonvulsant

Autism Symptoms Treated: Seizures, anxiety

Side Effects:  Sedation, slurred speech, ataxia, anion gap metabolic acidosis, dependence

Contraindications:  Narrow angle glaucoma, history of hypersensitivity to benzodiazepines, liver disease

Black Box Warning: Yes – “Risk from concomitant use with opioids.”

Notes:  On-going use may impact brain development in young children.

 

Generic Name: Clozapine

Brand Name:  Clozaril, Fazaclo, Versacloz

Category: Antipsychotic

Autism Symptoms Treated: Aggression, tantrums

Side Effects:  Sedation, constipation, urinary retention, increased salivation, dyslipidemia (imbalance in lipids such as cholesterol, HDL, LDL), hepatic steatosis (fatty liver disease), glucose intolerance, agranulocytosis (an unusually low number of granulocytes – a type of white blood cell), myocarditis (heart muscle inflammation), cardiomyopathy (when the heart has difficulty pumping blood to body), dystonia (involuntary muscle movements), akathisia (inability to sit still), parkinsonism (slow or rigid movements and tremors – not to be confused with Parkinson’s Disease), tardive dyskinesia (uncontrolled facial movements), muscular rigidity, autonomic instability (dysfunction of involuntary bodily functions such as blood pressure and heart rate), altered mental status, hyperthermia (abnormally high body temperature)

Contraindications:  Hypersensitivity to clozapine

Black Box Warning: Yes – “May cause severe neutropenia, which can lead to serious and fatal infections. Patients initiating and continuing treatment with clozapine must have a baseline blood absolute neutrophil count (ANC) measured before treatment initiation and regular ANC monitoring during treatment. Orthostatic hypotension, bradycardia, and syncope: risk is dose related. Starting dose is 12.5 mg. Titrate gradually and use divided dosages. Seizure: Risk is dose-related. Titrate gradually and use divided doses. Use with caution in patients with history of seizure or risk factors for seizure. Myocarditis, cardiomyopathy, and mitral valve Incompetence: Can be fatal. Discontinue and obtain cardiac evaluation if findings suggest these cardiac reactions. Increased mortality in Elderly patients with dementia-related psychosis.”

 

Generic Name: Desipramine

Brand Name:  Norpramin

Category: Tricyclic

Autism Symptoms Treated: Hyperactivity, attention deficit hyperactivity disorder

Side Effects:  Drowsiness, difficulty concentrating, hallucinations, excitement, confusion, dry mouth, blurred vision, urinary retention

Contraindications:  In recovery from myocardial infarction, on-going use of an MAOI or use of an MAOI within the last 14 days, hypersensitivity to desipramine or dibenzazepines

Black Box Warning: Yes – “Suicidality and antidepressants. Antidepressants including desipramine increased the risk of suicidal thinking and behaviors in children and young adults under the age of 24. Patients of all ages starting desipramine should be monitored for suicidality and unusual changes in behavior. Increased risk of suicidality.”

 

Generic Name: Diazepam

Brand Name:  Valium, Diastat, Valtoco

Category: Depressant, used as an anticonvulsant in autism

Autism Symptoms Treated:  Anxiety, seizures

Side Effects:  Sedation, slurred speech, ataxia, anion gap acidosis, dependence

Contraindications:  Narrow angle glaucoma, hypersensitivity to diazepam, myasthenia gravis, hepatic insufficiency, respiratory insufficiency, sleep apnea syndrome

Black Box Warning: Yes – “Increased risk of profound sedation if use concomitantly with opioids. Risk of abuse, misuse, addiction, physical dependence, and withdrawal reactions.”

Notes:  Should not be used by children under six months of age and long-term use may alter brain development of children

 

Generic Name: Escitalopram

Brand Name:  Lexapro

Category: SSRI, used to treat anxiety in autism

Autism Symptoms Treated:  Anxiety, social phobia, obsessive compulsive disorder

Side Effects:  Common: nausea, vomiting, dry mouth, somnolence, insomnia, sweating, tremor, diarrhea, dyspepsia, anxiety, decreased libido, asthenia, myalgia, rash, weight gain.  Severe:  suicidality, worsening depression, serotonin syndrome, mania, elevated liver enzymes, hyponatremia, SIADH, priapism, anaphylactoid reaction, hypoglycemia, extra pyramidal reactions, tachycardia, abnormal platelet aggregation, hepatitis.  Withdrawal if abruptly stopped.

Contraindications:  Increased use of serotonin syndrome if used with an MAOI, use of an MAOI within the previous 14 days, use of pimozide, hypersensitivity to citalopram or escitalopram

Black Box Warning: Yes – “Increased risk of suicidality, particular in pediatric and young adult patients. Not approved for use under 12 years of age.”

 

Generic Name: Fluoxetine

Brand Name:  Prozac, Sarafem, Rapiflux, Selfemra

Category: Selective Serotonin Re-uptake Inhibitor (SSRI)

Autism Symptoms Treated: Depression, obsessive compulsive disorder, panic disorder

Side Effects:  Somnolence, dizziness, insomnia, nervousness, headache, nausea, vomiting, diarrhea, hyponatremia

Contraindications: On-going use of an MAOI or use of an MAOI within the last 14 days, use of pimozide or thioridazine

Black Box Warning: Yes – “Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder (MDD) and other psychiatric disorders. Closely monitor patients being started on antidepressants for suicidal ideation or other changes in behavior.”

 

Generic Name: Guanfacine

Brand Name:  Tenex, Intuniv

Category: Sleep Aid, works on alpha adrenergic receptors

Autism Symptoms Treated: Hyperactivity, attention deficit hyperactivity disorder

Side Effects:  orthostatic hypotension, bradycardia, somnolence, constipation, indigestion, nausea, dizziness, headache, fatigue

Contraindications:  Hypersensitivity to guanfacine

Black Box Warning: None

Notes:  In particular, children are more likely to experience somnolence, abdominal pain, hypotension, dry mouth, and constipation as side effects

 

Generic Name: Lamotrigine

Brand Name:  Lamictal

Category: Anticonvulsant

Autism Symptoms Treated:  Seizures

Side Effects:  Common: weight gain, amnesia, nervousness, thought disturbances.  Less Common:  headache, dizziness, visual disturbances, gastrointestinal disturbances, hypotension, leukopenia, anemia, hematuria, elevated liver enzymes, rashes.  Rare: disseminated intravascular coagulation, acute renal failure, aseptic meningitis, Steven Johnson Syndrome, toxic epidermal necrolysis, rhabdomyolysis

Contraindications:  Hypersensitivity to lamotrigine

Black Box Warning: Yes – “Cases of life-threatening serious rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis, or rash-related death have been caused by lamotrigine. The rate of serious rash is greater in pediatric patients than in adults. Additional factors that may increase the risk of rash include: (1) coadministration with valproate; (2) exceeding recommended initial dose of lamotrigine; or (3) exceeding recommended dose escalation for lamotrigine. Benign rashes are also caused by lamotrigine; however, it is not possible to predict which rashes will prove to be serious or life threatening. Lamotrigine should be discontinued at the first sign of rash, unless the rash is clearly not drug related.”

 

Generic Name: Melatonin

Brand Name: N/A 

Category: Sleep Aid

Autism Symptoms Treated: Sleep disturbances, insomnia

Side Effects:  Generally safe, though patients may experience lethargy, confusion, fatigue, headache, pruritus, vasodilation, tachycardia, hypothermia

Contraindications:  Hypersensitivity to melatonin

Black Box Warning: Not regulated by the FDA

Notes:  Melatonin is technically a supplement (not a drug), so its regulation falls outside of the purview of the FDA.  While melatonin is generally very safe, please note that the potency between doses may vary.

 

Generic Name: Methylphenidate

Brand Name:  Ritalin, Daytrana, Cotempla

Category: Stimulant

Autism Symptoms Treated: Attention deficit hyperactivity disorder

Side Effects:  Common: anxiety, insomnia.  Other Effects:  Anorexia, nausea, vomiting, dizziness, dry mouth, palpitations, headaches, dyskinesia, lethargy, mydriasis, arthralgia, myagia, changes in blood pressure, tachycardia, bradycardia, angina, cardiac dysrhythmias, abdominal pain, elevated liver enzymes, and hypersensitivity reactions such as angioedema, anaphylactic reactions, exfoliative conditions, and auricular swelling.  Rare: Tourette’s syndrome, toxic psychosis. Sudden death has been reported with CNS stimulants at normal doses in children and adolescents with structural cardiac abnormalities or other serious heart problems. Sudden death and myocardial infarction has also been described in adults taking stimulant drugs at normal doses for ADHD.

Contraindications:  On-going use of an MAOI or use of an MAOI within the last 14 days, glaucoma, hypersensitivity to methylphenidate, marked agitation or anxiety, motor tics, Tourette syndrome

Black Box Warning: Yes – “CNS stimulants, including methylphenidate-containing products and amphetamines, have a high potential for abuse and dependence. Long term abusive use may lead to psychotic episodes.”

 

Generic Name: Olanzapine

Brand Name:  Zyprexa

Category: Antipsychotic

Autism Symptoms Treated:  Agitation

Side Effects:  Nausea, vomiting, dry mouth, constipation, dyspepsia, sedation, dizziness, tachycardia, orthostatic hypotension, elevated liver enzymes, arthralgia, extremity pain, elevated serum CPK, anticholinergic effects, orthostasis, agitation, insomnia, nervousness, constipation, and dry mouth have been reported with therapeutic use.  Long-Term Use: may cause weight gain and glucose intolerance. In the post-marketing period, there have been rare reports of hepatitis and cholestatic or mixed liver injury. Neuroleptic malignant syndrome (NMS), due to dopaminergic blockade, associated with olanzapine therapy has been reported, but is rare.

Contraindications:  Undetermined

Black Box Warning: Yes – “Increased risk of death in elderly patients with dementia-related psychosis.”

 

Generic Name: Quetiapine

Brand Name:  Seroquil

Category: Antipsychotic

Autism Symptoms Treated:  Anxiety

Side Effects:  Somnolence, dizziness, sinus tachycardia, palpitations, orthostatic hypotension, dry mouth, constipation, urinary retention, dyspepsia, elevated liver enzymes.

Contraindications: Hypersensitivity to quetiapine

Black Box Warning: Yes – “Increased risk of death in elderly patients with dementia-related psychosis.”

 

Generic Name: Risperidone

Brand Name:  Risperdal

Category: Antipsychotic

Autism Symptoms Treated: Irritability, anxiety

Side Effects: Nausea, diarrhea, constipation, dizziness, somnolence, tachycardia, orthostatic hypotension, extrapyramidal disorder, neuroleptic malignant syndrome.

Contraindications: Hypersensitivity to Risperdal

Black Box Warning: Yes – “Increased risk of death in elderly patients with dementia-related psychosis.”

Notes: FDA Approved for treating autism

 

Generic Name: Sertraline

Brand Name:  Zoloft

Category: Selective Serotonin Re-uptake Inhibitor (SSRI)

Autism Symptoms Treated:  Irritability, aggression, anxiety

Side Effects:  Agitation, insomnia, headache, dizziness, somnolence, and fatigue are among the most frequently reported side effects of sertraline.   Other Effects Include:  ataxia, incoordination, vertigo, abnormal dreams, aggressive behavior, delusions, hallucinations, emotional lability, paranoia, suicidal ideation, akathisia, tingling, extrapyramidal symptoms, dystonia, exacerbation of tics, mania, depersonalization, feelings of panic, palpitations, chest pain, hypertension, hypotension, edema, peripheral ischemia, syncope, tachycardia, nausea, diarrhea, dysphagia, gastritis, glossitis, gum hyperplasia, hiccups, stomatitis, tenesmus, constipation, indigestion, anorexia, flatulence, abdominal pain, increased appetite, eructation, tongue ulceration, incontinence, urinary frequency, dysuria, urinary retention, urinary incontinence, dysmenorrhea, intermenstrual bleeding, amenorrhea, menorrhagia, leukorrhea, atrophic vaginitis, gynecomastia, galactorrhea, breast pain, breast enlargement, renal pain, exophthalmos, xerophthalmia, blurred vision, diplopia, photophobia, tearing, conjunctivitis, eye pain, mydriasis, myalgia, arthralgia, dystonia, bronchospasm, dyspnea, cough, hyperventilation, diaphoresis, dermatitis, hyponatremia secondary to SIADH, elevated liver enzymes.

Contraindications:  On-going use of disulfiram, on-going use of an MAOI or use of an MAOI within the last 14 days, On-going use of pimozide, hypersensitivity to sertraline

Black Box Warning: Yes – “Increased risk of suicidality, particularly in people under 24 years old.”

 

Generic Name: Topiramate

Brand Name:  Topamax, Topiragen, Trokendi, Qudexy, Eprontia

Category: Anticonvulsant

Autism Symptoms Treated: Seizures

Side Effects:  Common: paresthesia, fatigue, nausea, anorexia, dizziness, weight decrease, diarrhea, difficulty with memory and concentration, somnolence.  Less Frequent: anxiety, depression, hypoesthesia, mood problems, dry mouth, confusion, involuntary muscle contractions, abnormal vision, renal calculus, hyperchloremic metabolic acidosis.  Infrequent:  auditory and visual hallucinations

Contraindications:  Recent alcohol use

Black Box Warning: None

 

Generic Name: Trazodone

Brand Name:  Desyrel, Trazodone D, Oleptro

Category: Antidepressant, used as a sleep aid

Autism Symptoms Treated:  Insomnia

Side Effects:  Drowsiness, nausea, vomiting, myoclonus, tinnitus, peripheral edema, priapism, toxic hepatitis, withdrawal syndrome, parkinsonism

Contraindications:  On-going use of an MAOI or use of an MAOI within the last 14 days, on-going use of saquinavir/ritonavir, hypersensitivity to trazodone

Black Box Warning: Yes – “Antidepressants increased the risk compared to placebo of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder (MDD) and other psychiatric disorders in short-term studies. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults beyond age 24, and there was a reduction in risk with antidepressants compared with placebo in adults aged 65 or older. The use of trazodone hydrochloride or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Closely monitor patients of all ages for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Not approved for pediatric use.”

 

If you are curious about a medication that we have not listed, please Contact Us!  We are happy to add more medications to this list based on user feedback.

 

References:

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwihr_P6wcD8AhVKj4kEHfxlDt0QFnoECAoQAQ&url=https%3A%2F%2Fwww.accessdata.fda.gov%2Fdrugsatfda_docs%2Flabel%2F2018%2F020272s080%2C020588s068%2C021444s054lbl.pdf&usg=AOvVaw2pvxvBQTCtxovhdtxBNzza

 

(2022), “Appendix A: FDA Boxed Warnings,” The APhA Complete Review for Pharmacy, 13th Edition. https://doi.org/10.21019/9781582123615.appa

 

LeClerc S, Easley D. Pharmacological therapies for autism spectrum disorder: a review. P T. 2015 Jun;40(6):389-97. PMID: 26045648; PMCID: PMC4450669.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450669/

 

King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, Donnelly CL, Anagnostou E, Dukes K, Sullivan L, Hirtz D, Wagner A, Ritz L; STAART Psychopharmacology Network. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry. 2009 Jun;66(6):583-90. doi: 10.1001/archgenpsychiatry.2009.30. PMID: 19487623; PMCID: PMC4112556.  https://pubmed.ncbi.nlm.nih.gov/19487623/

 

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