Hellings J. Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry 2023; 13(6): 262-277 [PMID: 37383284 DOI: 10.5498/wjp.v13.i6.262]
Corresponding Author of This Article
Jessica Hellings, MB.BCh., MMed, Professor, Department of Psychiatry, University of Missouri-Kansas City, 300 SE Second St, Lee's Summit, MO 64063, United States. jessica.hellings@uhkc.org
Research Domain of This Article
Psychiatry
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Jun 19, 2023; 13(6): 262-277 Published online Jun 19, 2023. doi: 10.5498/wjp.v13.i6.262
Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials
Jessica Hellings
Jessica Hellings, Department of Psychiatry, University of Missouri-Kansas City, Lee's Summit, MO 64063, United States
Author contributions: Hellings J is responsible for all contributions to this manuscript.
Conflict-of-interest statement: The author has been an investigator for Janssen Pharmaceuticals, Abbott Laboratories, Forest Laboratories, Supernus, Young Living Essential Oils, NIMH and NICHD. NICHD previously funded a risperidone program project grant with the author as principal investigator of the drug study project. The author currently has internal funding from University of Missouri-Kansas City to study amitriptyline in ASD.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jessica Hellings, MB.BCh., MMed, Professor, Department of Psychiatry, University of Missouri-Kansas City, 300 SE Second St, Lee's Summit, MO 64063, United States. jessica.hellings@uhkc.org
Received: December 28, 2022 Peer-review started: December 28, 2022 First decision: February 21, 2023 Revised: March 6, 2023 Accepted: April 18, 2023 Article in press: April 18, 2023 Published online: June 19, 2023 Processing time: 172 Days and 12.1 Hours
Core Tip
Core Tip: Most prescribing in autism spectrum disorders (ASD) is off-label; only risperidone and aripiprazole are Federal Drug Administration-approved in ASD, for irritability. Atypical antipsychotics are associated with metabolic side effects. Loxapine at 5-10 mg/day resembled an atypical antipsychotic in positron emission tomography studies; preliminary studies and clinical experience in ASD suggest efficacy and a promising metabolic profile. Controlled attention deficit hyperactivity disorder (ADHD) medication trials in ASD youth include methylphenidate, atomoxetine and guanfacine. The author recommends dextroamphetamine as an important treatment option for ADHD in ASD. Amitriptyline often improves impulsive aggression, self-injury, sleep, anxiety and enuresis. This article recommends additional older drug trials in ASD: Detroamphetamine, amitriptyline, loxapine, and lamotrigine for likely seizures.
