CPAN Case of the Month – April 2024

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Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a pediatrician during this consultation.

Patient: 10-year-old patient

Reason for CPAN Consultation: To receive support with a diagnosis and medication management

Explanation of the Case and Outcome of the Call:

A 10-year-old male seen by a pediatrician currently taking a small dose rog viloxazine at 200 mg for ADHD was started recently on Requip 0.25 mg for restless leg syndrome. The child had been displaying a delayed onset of angry irritable behavior without having any known stressors. Several interesting points were discussed starting with, “what is the diagnosis?” Two, youth with ADHD often have disruptive sleep. Third, there are significant drug-drug interactions with strong inhibition of CYP1A2 by viloaxazine increasing Requip levels likely the culprit for the sudden angry irritable behavior. Fourth, given the concern for restless legs, checking for iron deficiency may be important. Finally, the ADHD treatment was likely underdosed which is a common problem that can lead to polypharmacy if not addressed. Several options were discussed, but ultimately discontinuing the Requip along with a one-time direct consultation with the youth was suggested to assist in clarifying the diagnosis and helping guide the physician as to next steps.