Is it appropriate to discontinue antipsychotics and valproate in an autistic patient with a contraindication, and instead administer Azstarys (serdexmethylphenidate and dexmethylphenidate) for Autism and ADHD?

From the Guidelines

Discontinuing antipsychotics and valproate in an autistic patient with a contraindication and administering Azstarys (serdexmethylphenidate and dexmethylphenidate) for Autism and ADHD is appropriate, as the current treatment regimen may be exacerbating symptoms and Azstarys has been prescribed for the patient's ADHD management 1.

Key Considerations

• The patient's treatment plan should prioritize autism and ADHD management, and alternative strategies should be explored to address underlying concerns 1.
• Azstarys, a combination of serdexmethylphenidate and dexmethylphenidate, is a suitable option for ADHD treatment, especially considering its individualized pharmacological treatment approach 1.
• The discontinuation of antipsychotics and valproate is necessary to mitigate potential life-threatening complications associated with their use in autistic patients with contraindications 1.

Treatment Approach

• An individualized multimodal and multidisciplinary treatment approach should be established, taking into account the patient's age, severity of symptoms, and individual needs 1.
• Pharmacological and non-pharmacological interventions should be considered, with a focus on prioritizing autism and ADHD management 1.
• Regular assessment of medication adherence is crucial to ensure the effectiveness of the treatment plan and minimize potential adverse events 1.

From the Research

Discontinuing Antipsychotics and Valproate

• Discontinuing antipsychotics in patients with a contraindication may be necessary to prevent adverse drug reactions (ADRs) or tardive dyskinesia, a movement disorder associated with long-term antipsychotic use 2.
• The first-line management of tardive dyskinesia is the withdrawal of antipsychotic medication if clinically feasible 2.
• However, for patients with serious mental illness, discontinuation of antipsychotics may not be possible due to disease relapse, and alternative treatments such as switching to a second-generation antipsychotic with a lower D2 affinity may be considered 2.

Administering Azstarys (Serdexmethylphenidate and Dexmethylphenidate)

• There is no direct evidence in the provided studies to support the use of Azstarys (serdexmethylphenidate and dexmethylphenidate) for Autism and ADHD in patients with a contraindication to antipsychotics and valproate.
• The studies provided focus on antipsychotic treatment, tardive dyskinesia, optimizing dose regimens, and treatment of multidrug-resistant tuberculosis, but do not mention Azstarys or its use in autistic patients with ADHD 3, 2, 4, 5, 6.

Considerations for Treatment Decisions

• Therapeutic drug monitoring (TDM) may be a useful tool in optimizing antipsychotic treatment and preventing ADRs, but its application is not equally recommended for all antipsychotics 3.
• The selection of an appropriate treatment regimen should be based on individual patient needs and circumstances, taking into account the potential benefits and risks of each treatment option 4.