Unwanted Interactions Among Psychotropic Drugs and Other Treatments for Autism Spectrum Disorders

Abstract

A utism spectrum disorders (ASD) are pervasive neurodevelopmental disorders affecting approximately 1% of children and characterized by varying degrees of deficiencies in social interactions, concentration, language, learning, and as stereotypic behaviors. 1Y3 Many children develop ASD by regression at approximately age 3 years, often after a specific event such as vaccination or infection, although they were developing normally. 4,5 Some gene variants in ASD confer altered vulnerability to environmental stressors and exposures. 6 Behavioral interventions alone are not sufficient to adequately address the disruptive nature of ASD symptoms and their persistence throughout life. 7,8 Instead, psychotropic drug therapy is typically used to treat irritability, hyperactivity, inattention, obsessive-compulsive symptoms, aggression, and self-injury. 9Y11 Many children with ASD also develop seizures with no apparent underlying pathological cause, 12Y14 but traditional antiseizure medications seem to worsen ASD symptoms. 15 Overall, 70% of children with ASD take at least 10 different drugs, dietary supplements, vitamins, or other treatments 10,16Y18 including intravenous immunoglobulin. 19 Secretin is also commonly used although it has no effect 20 and could lead to the risk of possible inflammatory complications. 21 There is little attention to unwanted drug-drug or drug-supplement interactions. ANTIPSYCHOTICSA cross-sectional study of a child and adolescent psychiatric sample nationwide in Denmark found that the prevalence of treatment with antipsychotic medications was 6.4%. 22 Some pediatric patients were prescribed additional medications, with 24% receiving antidepressants, 8% receiving sedative medications, and 4% receiving psychostimulants. 22 Many children with ASD also take antipsychotic medications. 23 In a national sample of children and adolescents with ASD, the percentage of outpatients being treated with antipsychotic medications was almost 30%. 24 Risperidone is the only antipsychotic drug with Food and Drug Administration approval for treating aggressiveness and stereotypic and self-injurious behaviors in ASD. 25 This class of drugs also includes haloperidol and the newer ''atypical '' compounds. 26,27 Aripiprazole is an atypical antipsychotic approved for treating irritability in children with ASD. 28 A review of 21 randomized placebo-controlled trials using psychopharmacologic agents 29 showed that only risperidone for aggressive behavior 30,31 and methylphenidate for hyperactivity 32 produced significant improvement in more than one study. 29 A recent systemic review of medical treatments for children with ASD concluded that only risperidone and aripiprazole had some benefit, but they had significant adverse effects. 33 For instance, they result in significant weight gain, whereas haloperidol use is limited owing to higher risks of extrapyramidal effects and tardive dyskinesia. Another study of children with ASD from a national registry showed that 35% of children with ASD received psychotropic medicati...

Brain “fog,” inflammation and obesity: key aspects of neuropsychiatric disorders improved by luteolin

“…Flavonoids are extensively metabolized (Chen et al, 2014 ) primarily through glucoronidation, methylation, and sulphation (Hollman et al, 1995 ; Hollman and Katan, 1997 ). Therefore, flavonoids must be used with caution when administered with other natural polyphenolic molecules (e.g., curcumin, resveratrol) or drugs metabolized by the liver as they may affect the blood levels of themselves or of other drugs (Theoharides and Asadi, 2012 ). Tetramethoxyluteolin is already methylated and less likely to affect liver metabolism, is more stable (Walle, 2007 ), and has better bioavailability (Wei et al, 2014 ).…”

Children with autism spectrum disorders, who improved with a luteolin-containing dietary formulation, show reduced serum levels of TNF and IL-6

“… 82 , 83 , 84 Unfortunately, children with ASDs are prescribed many other supplements and psychotropic drugs that may have unwanted drug interactions. 85 One way to deliver luteolin directly to the brain would be through intranasal administration through the cribriform plexus as shown before for another compound. 86 …”

Atopic diseases and inflammation of the brain in the pathogenesis of autism spectrum disorders

“… 176 As a result, there is increased polypharmacy 174 , 177 and risk of unwanted drug interactions. 178 …”