Pharmacotherapy for panic attack in children
Psychosocial interventions are first-line treatment for panic attack. If symptoms of a panic attack do not resolve with psychosocial intervention or rapid resolution of symptoms is needed in a crisis, pharmacotherapy may be used. Pharmacotherapy is ideally started by a clinician with expertise in using psychotropics in children. If a drug is required, use this concurrently with psychosocial interventions if possible.
Benzodiazepine use in children is not supported by controlled trials. Furthermore, benzodiazepine use is associated with increased risk of falls, memory problems, daytime sedation and dependence, and may cause paradoxical disinhibition in children. Nevertheless, a single dose of a benzodiazepine may be used if rapid resolution of symptoms is needed in a crisis, or to help alleviate acute panic symptoms and allow the child to engage in psychosocial treatment (eg exposure therapy in school refusal). Follow the principles of benzodiazepine use in anxiety disorders.
If a benzodiazepine is indicated for panic attack, a suitable regimen in children 6 years or older is:
1 clonazepam 250 to 500 micrograms orally, as a single dose panic attack (child) clonazepam
OR
1 diazepam 0.1 to 0.2 mg/kg (up to 5 mg) orally, as a single dose panic attack (child) diazepam
OR
1 lorazepam 0.5 to 1 mg orally, as a single dose1. panic attack (child) lorazepam
In the rare circumstance that pharmacotherapy is required in a child younger than 6 years, seek specialist advice on dosing.