GPs May Soon Prescribe ADHD Meds in France

The number of children diagnosed with sleep disorders like attention-deficit hyperactivity disorder (ADHD) is increasing. However, there is a significant shortage of healthcare professionals trained to manage these conditions.

Currently, only paediatricians, psychiatrists, and paediatric neurologists are authorised to diagnose ADHD and initiate drug treatment. The French National Authority for Health has recently urged public authorities to extend these responsibilities to general practitioners.

Xavier Angibault, MD, child psychiatrist at the Tours University Hospital, Tours, France, and the Chinonais Hospital Center, Indre-et-Loire, France, addressed this issue at the recent General Medicine Congress France. During a roundtable, he outlined the conditions and dosages under which treatments for sleep and ADHD could be prescribed to children.

Behavioural Interventions

Initially, behavioural interventions are recommended for children who experience sleep issues. These include establishing routines and promoting good lifestyle habits, such as avoiding screens before bedtime, as emphasised by Angibault. It is also crucial to screen children for sleep apnoea.

Drug intervention is considered only for persistent sleep disturbances, with hydroxyzine (Atarax) and trimeprazine (Alimemazine) being the primary choice. 

Hydroxyzine, used for anxiety-related insomnia, should be administered 30 minutes before bedtime. Alimemazine, which is suitable for sleep disturbances due to mental hyperactivity, is prescribed for children over 6 years old weighing more than 20 kg.

The dosage ranged from 5 mg/day for children weighing 20-40 kg to a maximum of 10 mg/day for those weighing 40-50 kg. 

Melatonin is also available to aid sleep initiation and prolonged release to address nocturnal awakenings.

The two melatonin products are Slenyto, containing 1 mg and 5 mg tablets for children aged 2 years or older, with a maximum dose of 10 mg, and Circadin, with a recommended dose of 2 mg once daily and a maximum dose of 10 mg.

Treatment

Since September 2021, specialists such as neurologists, psychiatrists, and paediatricians can prescribe methylphenidate, with the possibility of monthly prescription renewals by any practising doctor. The maximum dosage was set at 1 mg/kg/day, with prescriptions limited to 28 days. The name of the pharmacy must be specified for coverage by health insurance.

“The real difference for each one is the patient’s tolerance.”

“If a patient is on methylphenidate, the effectiveness of the treatment of hyperactivity, concentration, weight, appetite, and sleep needs to be monitored. Dosage and timing adjustments may be necessary,” emphasised Angibault. 

General practitioners must also monitor patients’ cardiovascular health, such as blood pressure, heart rate, palpitations, and neurological health in headaches, paralysis, and epilepsy, and be vigilant for any psychiatric symptoms, such as depression, anxiety, or suicidal thoughts. In cases of overdose, symptoms such as euphoria, high blood pressure, or agitation, and hallucinations. “If such side effects occur, contact the prescribing doctor so that he can see what is happening and can change the treatment,” said Angibault.

For practitioners seeking further information, Angibault recommended three key resources: 

• A pharmacological prescription assistance website
• Psychiatrienet, a clinical resource for psychiatric care in primary practice
• A thematic session on the prescription of psychotropic drugs for children and adolescents in general medicine, hosted by the General Medicine & Psychiatry 37 network

Angibault stated that he had no conflicts of interest. “My presentation is solely based on the recommendations and my personal practice,” he clarified.

This story was translated from Medscape’s French edition.