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Recent research from CanFASD, the national Fetal Alcohol Spectrum Disorder (FASD) research network in Canada, has developed guidelines for clinicians to follow when prescribing medications to people with FASD (Mela et al., 2020). An expert panel, guided by previous research, developed an algorithm which aims to streamline medication prescription and prevent the negative effects of overprescribing (Mela et al., 2018). When the correct balance is achieved, medication can be highly beneficial in supporting (not replacing) social and behavioural interventions.

The complex, multidomain impacts of FASD can make pharmacological intervention difficult. People with FASD often end up taking numerous medications at the same time, a practice known as polypharmacy. When the correct balance of medications is not achieved, polypharmacy can cause physical discomfort and emotional distress. Finding the correct balance of medications can change over time as people’s health, environment, habits and bodies change.

Medications that impact cognition (thought processes), mood, behaviour, and perception (the way you interpret what you see, hear, smell, taste, and feel), are known as psychotropic medications. This group of medications includes antianxiolytics, antidepressants, antipsychotics/neuroleptics, mood stabilisers, and stimulants. Each of these medications can impact brain function in different ways so are used to target different specific domains affected by FASD.

Prescribing psychotropic medications can be difficult because everyone responds differently. If medications are prescribed to someone with FASD it is important for the individuals and parents or carers to discuss any changes, positive or negative, with the prescribing doctor at regular reviews. These reviews will help the doctor adjust the medications to find the best balance for the individual, which may take some time. It is very important to understand that many psychotropic medications cannot be stopped abruptly. If the medication is causing negative side effects these can become worse if the medication is stopped; discuss with the prescribing doctor the safest way to decrease the medication.

The algorithm developed to guide the integration of medication into FASD treatment includes five stages:

Stage 1 – Diagnosis and nonpharmacological interventions.

Targeted domains Outcome
Academic performance

Adaptive functioning

Affect regulation



Executive functioning



Motor skills

Reduced stress

Improved behaviour and responsiveness

Increased meaningful engagement in school, work, and relationships

Stage 2 – Domain-specific pharmacological intervention. Maximum two medications for children and four for adults.

Domain Signs & Symptoms Treatment
Hyperarousal Hypervigilance








Reduced pain threshold

Adrenergic Agent

·        Clonidine

·        Guanfacine

Emotion Regulation Mood swings




Mood Stabiliser

·        Divaloprex

·        Lamotrigine

Hyperactive/ Neurocognitive Restless movement



Executive dysfunction

Amphetamine Based Stimulants

·        Lisdexamfetamine

·        Dexedrine

Cognitive Inflexibility Impairments in:

Perspective taking

Frustration tolerance

Social skills


Reality testing


Atypical Neuroleptic

·        Risperidone*


Stage 3 – Domain-specific pharmacological intervention plus primary and secondary domain-specific intervention. These additional medications should not exceed the limit of two medications for children and four for adults.

Domain Treatment
Hyperarousal SSRI

·        Fluoxetine*

·        Citalopram*

·        Sertraline*

Emotion Regulation SSRI

·        Fluoxetine*

·        Citalopram*

·        Sertraline*

Hyperactive/ Neurocognitive Other Stimulants

·        Methylphenidate

·        Atomoxetine

·        Bupropion

Cognitive Inflexibility Atypical Neuroleptic

·        Olanzapine

·        Aripiprazole


Stage 4 – Traditional treatment algorithms for comorbid disorders such as depression and anxiety, and Attention Deficit Hyperactivity Disorder.

Stage 5 (ADULTS ONLY) – Consider adjunctive medications but note there is minimal research supporting these recommendations. These medications include:

Signs & Symptoms Treatment
General Nutritional Supplement

·        Omega-3

·        Choline

·        Iron

·        Glutamine


·        Cannabidiol

Insomnia Antidepressant

·        Mirtazapine

·        Trazodone

Amino Acid

·        Tryptophan

Cognition Tetracycline Antibiotic

·        Minocycline

Mood Mood Stabiliser

·        Vortioxetine

Hyperarousal Alpha Blocker

·        Prazosin

Beta Blocker

·        Propranolol

Mela and colleagues (2020) research is the first step in defining a staged medication approach to treat FASD. More research will be required over the next decade to review its success in reducing polypharmacy and improving the daily life of people living with FASD.

If you are a parent, carer, or person living with FASD and you have questions about medications, speak to your treating clinicians.

If you are a doctor using this prescription algorithm, the authors would like to hear your feedback. Please contact Dr Mela Mansfield on

Read more NOFASD Australia blogs


Mela, M., Hanlon-Dearman, A., Ahmed, A. G., Rich, S., Densmore, R., Reid, D., Barr, A., Osser, D., Anderson, T., Suberu, B., Ipsiroglu, O., Rajani, H., & Loock, C. (2020). Treatment algorithm for the use of psychopharmacological agents in individuals prenatally exposed to alcohol and/or with diagnosis of fetal alcohol spectrum disorder (FASD). Journal of Population Therapeutics and Clinical Pharmacology, 27(3), e1–e13.

Mela, M., Okpalauwaeke, U., Anderson, T., Eng, J., Nomani, S., Ahmed, A., & Barr, A. (2018). The utility of psychotropic drugs on patients with Fetal Alcohol Spectrum Disorder (FASD): A systematic review. Psychiatry and Clinical Psychopharmacology, 28(4), 436-445. https:// 10.1080/24750573.2018.1458429

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