A retrospective study of amitriptyline in youth with autism spectrum disorders.
Low-dose amitriptyline gave six in ten medication-resistant autistic kids clear hyperactivity relief across three years of clinic charts.
01Research in Context
What this study did
Doctors looked back at 50 kids with autism who took low-dose amitriptyline. The kids had failed other meds for hyperactivity and impulsivity.
Each child was rated with the Clinical Global Impression scale every visit for about three years.
What they found
Six out of ten kids reached 'much improved' at their last visit. Eight out of ten hit that mark at least half the time.
The drug was used off-label and doses stayed low.
How this fits with other research
Patra et al. (2019) pooled three atomoxetine trials in autistic kids. Atomoxetine also cut parent-rated hyperactivity, but caused stomach pain and sleep loss. Amitriptyline may offer an option when stimulant-like drugs fail.
Guest et al. (2013) ran a similar 2013 case series with oxcarbazepine for irritability. Both papers show modest gains and high dropout risk, warning us to watch side-effects closely.
Hudson et al. (2012) scanned 33 RCTs and found solid evidence for only a few autism meds. Their review reminds us that case-series data like Irfan’s sit low on the evidence ladder.
Why it matters
If you support a child who stays hyper on stimulants or atomoxetine, low-dose amitriptyline could be worth a pharmacy consult. Track CGI-I each month and watch for fatigue, dry mouth, or mood shifts. Pair the med trial with solid behavior plans so gains stick even if the drug stops.
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02At a glance
03Original abstract
We performed a retrospective chart review of 50 youths with Autism Spectrum Disorder (ASD), prescribed amitriptyline (AMI) for hyperactivity and impulsivity. Data was systematically extracted from 50 outpatient clinic charts, including AMI treatment duration, dose, trough levels and adverse events. Mean age was 9.4 years (4.6-17.9); 40 were males and 10 females. 30 % had failed atomoxetine and 40 % had failed ≥3 ADHD medications. Mean dose was 1.3 ± 0.6 mg/kg/day, mean trough level 114.1 ± 50.5 ng/ml, mean duration 3.4 years. Clinical Global Impressions Scale-Improvement (CGI-I) was ≤2 in 60 % of patients at the final visit, and in 82 % of patients for at least 50 % of follow-ups. Cautious use of low dose AMI shows promise for treatment-resistant youth with ASD accompanied by hyperactivity, impulsivity, aggression and self injury.
Journal of autism and developmental disorders, 2013 · doi:10.1007/s10803-012-1647-0