The psychopharmacology algorithm project at the Harvard South Shore Program: An algorithm for core symptoms of autism spectrum disorder in adults. (May 2020) - Gannon, Shivaun
Highlights: There are limited data pertinent to prescribing for core symptoms of autism spectrum disorder (ASD) in adults. For instances when pharmacological management is chosen by prescribers and patients as part of the treatment plan, consider fluvoxamine as first-line for restricted, repetitive behaviors. Pharmacological management of core symptoms of ASD should not be first-line or routine but only after careful consideration on a case-by-case basis, and it should be discontinued if there is no clear improvement. Abstract: Autism spectrum disorder (ASD) is characterized by impaired social communication and restricted repetitive behaviors and interests. There are no FDA-approved medications for these core symptoms, and there are limited data regarding pharmacological management of ASD in adults. Here, the literature was reviewed in an effort to develop an algorithm for pharmacological management of core symptoms of ASD in adults. The literature search was conducted using PubMed. It was very difficult to distil a plausible algorithm from these data. Not included in this review are behavioral strategies, which are first-line. For instances when medication is being considered for management of core ASD symptoms in adults, the authors suggest starting with fluvoxamine as first-line, with possible consideration of a second SSRI trial if there is an inadequate or no response to fluvoxamine. The next step, if there is comorbid irritability, is to consider a second-generation antipsychotic. If there is no comorbid irritability, in the final step of the tentative algorithm, there are possible augmenting agents: propranolol, memantine, d -cycloserine, and oxytocin. Management of the symptoms of ASD requires a comprehensive treatment approach, and treatment planning must be individualized. Treatment of core ASD symptoms is not always desired. Further studies are needed to develop a stronger evidence base to support pharmacological management of core symptoms.