Somnolence-Producing Agents: A 5-Year Study of Prescribing for Medicaid-Insured Children With Attention Deficit Hyperactivity Disorder

Area of Science:

• Pediatric pharmacology
• Neurodevelopmental disorders
• Medication safety

Background:

• Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
• Sleep disturbances are frequently observed in children diagnosed with ADHD.
• Medication management for ADHD often involves addressing co-occurring symptoms, including sleep issues.

Purpose of the Study:

• To evaluate the patterns of prescribing medications that induce somnolence to children with ADHD.
• To identify the specific medications and patient demographics involved in this prescribing trend.
• To assess the appropriateness of these prescriptions based on clinical guidelines and FDA approvals.

Main Methods:

• Observational study utilizing prescription claims data.
• Analysis of children aged 3-18 with ADHD diagnoses.
• Inclusion of prescription data from January 1, 2012, to December 31, 2016, in Oregon.
• Focus on Medicaid-insured children.

Main Results:

• 14,567 30-day supplies of sleep medication prescribed to 2,518 children with ADHD.
• Majority of prescriptions issued to males (66.3%) and adolescents aged 12-18 (63.8%).
• Frequently prescribed medications included trazodone, hydroxyzine, quetiapine, clonazepam, and amitriptyline; zaleplon and zolpidem were rarely prescribed.

Conclusions:

• Trazodone, hydroxyzine, and amitriptyline are frequently prescribed for pediatric ADHD patients despite lacking proven clinical efficacy or specific guidance for this indication.
• Quetiapine is often used off-label at sub-therapeutic doses for its sedative effects.
• Prescribing patterns favor mental health drugs with voluntary guidance and antihistamines over FDA-approved insomnia medications for children with ADHD.