Comparing Efficacy and Side Effects of Memantine vs. Risperidone in the Treatment of Autistic Disorder

Nikvarz Nikvarz; Javad Alaghband-Rad; Mehdi Tehrani-Doost; Abbas Alimadadi; Padideh Ghaeli

doi:10.1055/s-0042-108449

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2017; 50(01): 19-25
DOI: 10.1055/s-0042-108449

Original Paper

Comparing Efficacy and Side Effects of Memantine vs. Risperidone in the Treatment of Autistic Disorder

Nikvarz Nikvarz

¹Faculty of Pharmacy and Pharmaceutical Sciences, Kerman University of Medical Sciences, Kerman, Iran (the Islamic Republic of)

,

Javad Alaghband-Rad

²Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)

,

Mehdi Tehrani-Doost

²Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)

,

Abbas Alimadadi

³Department of Psychology, University of Applied Science and Technology, Tehran, Iran (the Islamic Republic of)

,

Padideh Ghaeli

⁴Faculty of Pharmacy and Pharmaceutical Sciences, and Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)

› Author Affiliations

Abstract

Introduction: This study was aimed to compare the efficacy and side effects of memantine, an antagonist of the NMDA receptor of glutamate, with risperidone given the fact that glutamate has been noted for its possible effects in the pathogenesis of autism. Risperidone, an atypical antipsychotic, has been approved by FDA for the management of irritability associated with autism.

Methods: 30 children, aged 4–17 years, entered an 8-week, randomized trial. Patients were randomly assigned to receive either risperidone or memantine. Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Clinical Global Impressions – Improvement (CGI-I) and Clinical Global Impression-Severity (CGI-S) scales were used to assess behavioral symptoms of the patients.

Results: Both risperidone and memantine reduced the scores of 4 subscales of ABC as well as the 10-item and the total score of CARS significantly. However, differences between the 2 drugs in the scores of each evaluating scale were not found to be significant. Relatively, larger number of patients on risperidone showed “very much improvement” when assessed by CGI-I scale when compared with those on memantine.

Discussion and conclusion: The present study suggests that memantine may have beneficial effects in the treatment of many core symptoms of autism. Therefore, memantine may be considered as a potential medication in the treatment of those autistic children who do not respond or cannot tolerate side effects of risperidone.

Key words

autistic disorders - risperidone - memanine

Full Text

References

References
1 Doyle CA, McDougle CJ. Pharmacologic treatments for the behavioral symptoms associated with autism spectrum disorders across the lifespan. Dialogues in Clinical Neuroscience 2012; 14: 263
2 Elsabbagh M, Divan G, Koh YJ et al. Global prevalence of autism and other pervasive developmental disorders. Autism Research 2012; 5: 160-179
3 Wink LK, Erickson CA, McDougle CJ. Pharmacologic treatment of behavioral symptoms associated with autism and other pervasive developmental disorders. Current Treatment Options in Neurology 2010; 12: 529-538
4 Bent S, Hendren RL. Improving the prediction of response to therapy in autism. Neurotherapeutics 2010; 7: 232-240
5 Pardo CA, Eberhart CG. The neurobiology of autism. Brain Pathology 2007; 17: 434-447
6 Carlson GC. Glutamate receptor dysfunction and drug targets across models of autism spectrum disorders. Pharmacology Biochemistry and Behavior 2012; 100: 850-854
7 Purcell A, Jeon O, Zimmerman A et al. Postmortem brain abnormalities of the glutamate neurotransmitter system in autism. Neurology 2001; 57: 1618-1628
8 Aldred S, Moore KM, Fitzgerald M et al. Plasma amino acid levels in children with autism and their families. Journal of Autism and Developmental Disorders 2003; 33: 93-97
9 Belsito KM, Law PA, Kirk KS et al. Lamotrigine therapy for autistic disorder: a randomized, double-blind, placebo-controlled trial. Journal of Autism and Developmental Disorders 2001; 31: 175-181
10 King BH, Wright D, Handen BL et al. Double-blind, placebo-controlled study of amantadine hydrochloride in the treatment of children with autistic disorder. Journal of the American Academy of Child & Adolescent Psychiatry 2001; 40: 658-665
11 Woodard C, Groden J, Goodwin M et al. A placebo double-blind pilot study of dextromethorphan for problematic behaviors in children with autism. Autism 2007; 11: 29-41
12 Chez MG, Burton Q, Dowling T et al. Memantine as adjunctive therapy in children diagnosed with autistic spectrum disorders: an observation of initial clinical response and maintenance tolerability. Journal of Child Neurology 2007; 22: 574-579
13 Erickson CA, Chambers JE. Memantine for disruptive behavior in autistic disorder. The Journal of Clinical Psychiatry 2006; 67: 1000
14 Erickson CA, Mullett JE, McDougle CJ. Open-label memantine in fragile X syndrome. Journal of Autism and Developmental Disorders 2009; 39: 1629-1635
15 Erickson CA, Posey DJ, Stigler KA et al. A retrospective study of memantine in children and adolescents with pervasive developmental disorders. Psychopharmacology 2007; 191: 141-147
16 Niederhofer H. Glutamate antagonists seem to be slightly effective in psychopharmacologic treatment of autism. Journal of Clinical Psychopharmacology 2007; 27: 317-318
17 Owley T, Salt J, Guter S et al. A Prospective, open-label trial of memantine in the treatment of cognitive, behavioral, and memory dysfunction in pervasive developmental disorders. Journal of Child & Adolescent Psychopharmacology 2006; 16: 517-524
18 Wei H, Dobkin C, Sheikh AM et al. The therapeutic effect of memantine through the stimulation of synapse formation and dendritic spine maturation in autism and fragile X syndrome. PloS One 2012; 7: e36981
19 Wink LK, Plawecki MH, Erickson CA et al. Emerging drugs for the treatment of symptoms associated with autism spectrum disorders. Expert Opinion on Emerging Drugs 2010; 15: 481-494
20 Cohen D, Raffin M, Canitano R et al. Risperidone or aripiprazole in children and adolescents with autism and/or intellectual disability: a Bayesian meta-analysis of efficacy and secondary effects. Research in Autism Spectrum Disorders 2013; 7: 167-175
21 Masi G, Cosenza A, Mucci M et al. Open trial of risperidone in 24 young children with pervasive developmental disorders. Journal of the American Academy of Child & Adolescent Psychiatry 2001; 40: 1206-1214
22 Rellini E, Tortolani D, Trillo S et al. Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC) correspondence and conflicts with DSM-IV criteria in diagnosis of autism. Journal of Autism and Developmental Disorders 2004; 34: 703-708
23 Karabekiroglu K, Aman MG. Validity of the aberrant behavior checklist in a clinical sample of toddlers. Child Psychiatry and Human Development 2009; 40: 99-110
24 Kadouri A, Corruble E, Falissard B. The improved Clinical Global Impression Scale (iCGI): development and validation in depression. BMC Psychiatry 2007; 7: 7
25 McCracken JT, McGough J, Shah B et al. Risperidone in children with autism and serious behavioral problems. New England Journal of Medicine 2002; 347: 314-321
26 McDougle CJ, Scahill L, Aman MG et al. Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology. American Journal of Psychiatry 2005; 162: 1142-1148
27 Pandina GJ, Bossie CA, Youssef E et al. Risperidone improves behavioral symptoms in children with autism in a randomized, double-blind, placebo-controlled trial. Journal of Autism and Developmental Disorders 2007; 37: 367-373
28 Zuddas A, DI Martino A, Muglia P et al. Long-term risperidone for pervasive developmental disorder: efficacy, tolerability, and discontinuation. Journal of Child and Adolescent Psychopharmacology 2000; 10: 79-90
29 McDougle CJ, Holmes JP, Carlson DC et al. A double-blind, placebo-controlled study of risperidone in adults with autistic disorder and other pervasive developmental disorders. Archives of General Psychiatry 1998; 55: 633-641
30 Shea S, Turgay A, Carroll A et al. Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics 2004; 114: e634-e641
31 Ghaleiha A, Asadabadi M, Mohammadi M-R et al. Memantine as adjunctive treatment to risperidone in children with autistic disorder: a randomized, double-blind, placebo-controlled trial. International Journal of Neuropsychopharmacology 2013; 16: 783-789