Medication Side Effects in Pediatric Psychiatry

Drug side effect issues?

My child is currently taking Strattera 25mg.
Recently, I've noticed that he has been easily prone to explosive anger, crying, and shouting.
Afterwards, he collapses and presents with stiff limbs and a vacant stare, and it takes a long time to get his attention again, which seems to resemble a seizure state.
Could the medication be causing this condition? After a verbal conflict with him today following a meal, he collapsed again and had foam at the mouth.
I'm unsure if this is due to acid reflux.
He mentioned that after he fell, he experienced a blank memory and had a rapid heartbeat.
Before taking Strattera, he was on Adderall XR, but it didn't help much with his academics and caused oral allergic ulcers, so the doctor recommended switching to Strattera.
Should we conduct an EEG to investigate this condition? Thank you, doctor.

Yu, 40~49 year old female. Ask Date: 2020/08/20

Dr. Liu Shikai reply Psychiatry

Dear Ms.
Fish,
Thank you for your inquiry.
Based on your description, it seems that your child may be experiencing a state of epilepsy.
As for the causes, current medical knowledge indicates that most cases remain idiopathic, while other potential causes are numerous and varied, including hypoglycemia, hypocalcemia, electrolyte imbalances, hypoxia, sleep deprivation, fatigue, febrile illnesses, stress, emotional distress, sensory stimuli, alcohol, drugs, or medications, all of which could potentially lead to a state of epilepsy.

Among these, medication factors also require careful evaluation.
Regarding Strattera (atomoxetine), a review of the literature concerning its safety indicates that the incidence of seizures while taking Strattera is low and does not show a statistically significant difference compared to placebo, suggesting that the risk is similar.
Furthermore, feedback from cases of seizures occurring during Strattera use revealed that many of these individuals had a prior history of seizures or other confounding factors.
For your child's suspected epileptic state, I recommend seeking further medical attention.
A physician should conduct a physical examination and laboratory tests to investigate possible causes and arrange subsequent treatment, ensuring a more comprehensive medical evaluation and management for your child.
Additionally, it is advisable to discuss the necessity of Strattera with the prescribing physician and consider alternative options.
Finally, I wish you and your child peace and good health.

Reply Date: 2020/08/20

More Info

When it comes to understanding medication side effects in pediatric psychiatry, particularly in the context of your child's recent experiences while on Strattera (atomoxetine), it is crucial to consider both the pharmacological effects of the medication and the potential for adverse reactions.

Strattera is a non-stimulant medication commonly prescribed for Attention Deficit Hyperactivity Disorder (ADHD). While it can be effective in managing symptoms, it is not without its side effects. Some of the more common side effects include fatigue, decreased appetite, nausea, and mood swings. However, more serious side effects can occur, including cardiovascular issues and, in rare cases, seizures.

The symptoms you describe—your child experiencing episodes of anger, crying, and then falling to the ground with stiff limbs and a vacant stare—are concerning. The fact that he has episodes where he appears unresponsive and has a rapid heartbeat raises the possibility of a seizure disorder. The presence of foam at the mouth can also be indicative of a seizure, although it could also be related to other issues such as gastroesophageal reflux disease (GERD) or a side effect of the medication.

Given that your child has a history of medication allergies and adverse reactions, it is essential to approach this situation with caution. The transition from a stimulant medication (like Ritalin) to Strattera may have altered his neurological responses, and the new symptoms could be a manifestation of this change. The fact that he does not remember the episodes suggests a significant alteration in consciousness, which is characteristic of seizures.

In terms of whether a brain wave test (EEG) is necessary, it would be prudent to consult with your child's psychiatrist or a neurologist. An EEG can help determine if there are any abnormal electrical activities in the brain that could indicate seizure activity. Additionally, it would be wise to discuss the possibility of adjusting the medication or exploring alternative treatments, especially if the current regimen is causing distressing side effects.

Moreover, it is essential to monitor your child's behavior closely and document any episodes, including their duration, frequency, and any preceding events (like conflicts or stressors). This information can be invaluable for healthcare providers in determining the best course of action.

In summary, while Strattera can be beneficial for managing ADHD symptoms, the side effects you are observing warrant immediate attention. It is crucial to communicate openly with your healthcare provider about these concerns, as they can help assess the situation and determine the appropriate diagnostic steps and treatment adjustments. Your child's safety and well-being should always be the priority, and timely intervention can make a significant difference in managing both his psychiatric needs and any potential neurological issues.

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