The use of medications approved for Alzheimer’s disease in autism spectrum disorder: a systematic review

• Main Authors: Daniel eRossignol, Richard Eugene Frye
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2014-08-01
• Series: Frontiers in Pediatrics
• Subjects: autism; Alzheimer’s disease; Medications; acetylcholinesterase inhibitors; NMDA antagonist
• Online Access: http://journal.frontiersin.org/Journal/10.3389/fped.2014.00087/full

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects 1 in 68 children in the United States. Even though it is a common disorder, only two medications (Risperidone and Aripiprazole) are approved by the U.S. Food and Drug Administration (FDA) to treat symptoms associated with ASD. However these medications are approved to treat irritability, which is not a core symptom of ASD. A number of novel medications which have not been approved by the FDA to treat ASD have been used off-label in some studies to treat ASD symptoms, including medications approved for Alzheimer’s disease. Interestingly, some of these studies are high quality, double-blind, placebo-controlled (DBPC) studies. This article systematically reviews studies published through April, 2014 which examined the use of Alzheimer’s medications in ASD, including donepezil (7 studies, 2 were DBPC, 5/7 reported improvements), galantamine (4 studies, 2 were DBPC, all reported improvements), rivastigmine (1 study reporting improvements), tacrine (1 study reporting improvements) and memantine (9 studies, 1 was DBPC, 8 reported improvements). An evidence-based scale was used to rank each medication. Collectively, these studies reported improvements in expressive language and communication, receptive language, social interaction, irritability, hyperactivity, attention, eye contact, emotional lability, repetitive or self-stimulatory behaviors, motor planning, disruptive behaviors, obsessive-compulsive symptoms, lethargy, overall ASD behaviors and increased REM sleep. Reported side effects are reviewed and include irritability, gastrointestinal problems, verbal or behavioral regression, headaches, irritability, rash, tremor, sedation, vomiting, and speech problems. Both galantamine and memantine had sufficient evidence ranking for improving both core and associated symptoms of ASD. Given the lack of medications approved to treat ASD, further studies on novel medications, including Alzheim