CPAN Case of the Month – May 2025
Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a PCP during this consultation.
Psychiatrist: Catherine Karni, MD
Consult: Appetite suppression in ADHD.
A 9-year-old female with ADHD, Dyslexia, and Dysgraphia is taking Concerta 27 mg. The medication has suppressed appetite despite its effectiveness at lower and higher dosages. The BMI has decreased from the 54th percentile to the 8th percentile over the span of 12 months. The patient also complained of stomach discomfort in the morning, and the teacher noted increased irritability around 2 pm. The PCP has tried a booster dosage of Focalin IR with increased appetite suppression. They have also tried IR twice daily dosing instead of a long-acting stimulate medication to improve appetite suppression without success.
The consultation recommended that the PCP consider the following. Utilization of Periactin 2mg 30 minutes before meals for appetite stimulation and Pediasure shakes to supplement during the day. Ensure that the patient takes her stimulate medication with food to avoid stomach pain. Periactin is safe to use with stimulant medications. Having improved caloric intake may also help with the afternoon irritability, as this symptom could be exacerbated by a lack of caloric intake. However, if the irritability were to remain, as well as concerns for the ADHD symptoms being functionally impairing in the afternoon/evening times, the family could consider an addition of Intuniv 1 mg. This medicine is not known to cause appetite suppression and could help with the irritability and remaining ADHD symptoms. All treatments come with risks and benefits, so it is important to discuss with the family and determine which steps to take next to address the child’s ADHD and resultant side effects of their effective treatment. Monitoring weight weekly, as well as blood pressure if Intuniv is added, will be important.