I n this column, I would like to make the readership aware of an important update. There is now competition in the extended release attention-deficit/hyperactivity disorder (ADHD) marketplace for alpha-adrenergic agonists. As the readership has been made aware, this past year Shire's product, Intuniv, received approval by the United States Food and Drug Administration (FDA). On October 10, 2010, Shionogi Pharmaceutical's new product, Kapvay, was also approved by the FDA. It is an extended-release version of clonidine. It is approved for the treatment of ADHD in patients between the ages of 6 and17 years old. Kapvay received approval as both a monotherapy agent or for use as adjunctive treatment with stimulants. Each of the Phase 3 studies demonstrated statistical improvement in the realms of hyperactivity, impulsivity, and inattention.

Interestingly, Kapvay is not the only approved extended-release version of clonidine. However, the other products are only approved for the treatment of hypertension in adults. Tris Pharmaceuticals received FDA approval in December 2009 for their product, and Shinogi has a version of the extended-release formula trademarked as Jenlog for hypertension, as well.

The agent is available as tablets in doses of 0.1 and 0.2 mg. Dosing of Kapvay should be started at 0.1 mg at bedtime, with adjusted weekly increments of 0.1 mg/day as needed, up to a maximum of 0.4 mg/day. It should be kept in mind that beyond the starting dose, the agent should be given in two daily administrations. As with short-acting clonidine, patients can develop hypotension, bradicardia, and syncope. Bradicardia may be accentuated when this agent is administered along with digitalis, calcium channel blockers, or beta-blockers. Discontinuation of this agent should take place as a taper, decreasing doses by no more than 0.1 mg every 3 to 7 days. In the short-term studies, somnolence was reported in about 30%–40% of patients. This diminished considerably in samples that received Kapvay in combination with a stimulant. With single-dose administration of Kapvay, clonidine plasma concentrations peaked in 3 to 5 hours. Plasma half-life varied from 12 to 16 hours. The half-life almost tripled in those individuals with severe renal impairment. Approximately, 40%–60% of the agent is recovered unchanged in the urine within 24 hours, and about 50% of the agent is metabolized in the liver.

I would like to make the readers aware of an article that provides some very interesting information. The study by Merikangas et al. (2010) represents the first study to examine the prevalence of mental disorders using DSM-IV criteria, in a nationally representative sample of 10,123 individuals who ranged in age from 13 to 18 years old. In this report nearly half the sample met criteria for one class of disorders, and almost a quarter of the sample experienced severe functional impairment. Anxiety disorders were the most common diagnose, evident in about 32% of the sample. This was followed by the presence of behavior disorders seen in just over 19% of the sample. Additionally, slightly over 11% of adolescents met criteria for a substance-use disorder. One of the most consistently associated factors with the presence of mental disorders was the level of parental education. Specifically, adolescents whose parents hadn't graduated from college were at increased risk for developing all classes of psychiatric disorders.

We are including an updated list of conferences for your consideration.

AACAP Psychopharmacology Update Institute will be held in Los Angeles, California, from January 21–22, 2011, contact (202) 966–7300.