Journal of the American Academy of Child & Adolescent Psychiatry
ReviewCardiovascular Risk of Stimulant Treatment in Pediatric Attention-Deficit/Hyperactivity Disorder: Update and Clinical Recommendations
Section snippets
Method
Relevant clinical literature on the CV effects of stimulant medications for ADHD was sought using two PubMed searches. In the first search, search terms included stimulant, methylphenidate and amphetamine, each combined with ADHD, and cardiovascular, cardiac, blood pressure, electrophysiology, ECG, severe adverse outcomes, and sudden death. Searches were limited to human studies and the English language through May 2011. In the second search, to ensure the capture of CV outcomes in the context
Short-Term Impact on Heart Rate and Blood Pressure
Controlled studies conducted during the 1970s and 1980s described the acute CV response 1 to 2 hours after administration of immediate-release (IR) stimulants, largely methylphenidate (MPH). These studies primarily involved small samples of school-age Caucasian children with ADHD symptomatology.9, 10 Compared with the āminorā impact on BP, HR was viewed as highly sensitive to MPH,23 with significant increases compared with placebo, and greater elevations in medication-naive children than in
Discussion
This review outlines what is known about the CV impact of therapeutic stimulant medication for pediatric ADHD, and what remains uncertain. Consistent with the sympathomimetic nature of these agents, mean elevations in BP (ā¤5 mmHg) and HR (ā¤10 beats/min) have been seen in samples of children and adolescents with ADHD. Greater increases in BP or HR can be expected in a sizeable minority (5-15%), although the limited literature has suggested that multiple elevated BP readings occur in fewer
References (101)
Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder
J Am Acad Child Adolesc Psychiatry
(2007)- et al.
ADHD and methylphenidate: a review of height/weight, cardiovascular, and somatic complaint side effects
Clin Psychol Rev
(2002) Understanding the risk of using medications for ADHD with respect to physical growth and cardiovascular function
Child Adolesc Psychiatr Clin North Am
(2008)- et al.
Short term cardiovascular effects of methylphenidate and Adderall
J Am Acad Child Adolesc Psychiatry
(2001) - et al.
A dose-ranging study of a methylphenidate transdermal system in children with ADHD
J Am Acad Child Adolesc Psychiatry
(2005) - et al.
Efficacy and safety of dexmethylphenidate extended-release capsules in children with ADHD
J Am Acad Child Adolesc Psychiatry
(2006) - et al.
Short and long term cardiovascular effects of mixed amphetamine salts extended release in children
J Pediatr
(2005) - et al.
Cardiovascular effects of mixed amphetamine salts extended release in the treatment of school-aged children with ADHD
Biol Psychiatry
(2007) - et al.
Lisdexamfetamine dimesylate and mixed amphetamine salts extended-release in children with ADHD: a double-blind, placebo-controlled, crossover analog classroom study
Biol Psychiatry
(2007) - et al.
Pharmacokinetics of lisdexamfetamine dimesylate and its active metabolite, d-amphetamine, with increasing oral doses of lisdexamfetamine dimesylate in children with ADHD: a single-dose, randomized, open-label, crossover study
Clin Ther
(2010)
ADHD treatment with once-daily OROS methylphenidate: final results from a long-term open-label study
J Am Acad Child Adolesc Psychiatry
Long-term tolerability and effectiveness of once-daily mixed amphetamine salts (Adderall XR) in children with ADHD
J Am Acad Child Adolesc Psychiatry
Long-term tolerability of the methylphenidate transdermal system in pediatric attention-deficit/hyperactivity disorder: a multicenter, prospective, 12-month, open-label, uncontrolled, phase III extension of four clinical trials
Clin Ther
The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study
J Am Acad Child Adolesc Psychiatry
Electrocardiographic screening in children with attention-deficit hyperactivity disorder
Am J Cardiol
Paying attention to stimulants: height, weight, and cardiovascular monitoring in clinical practice
J Am Acad Child Adolesc Psychiatry
AHA scientific statement: cardiovascular monitoring of children and adolescents receiving psychotropic drugs
J Am Acad Child Adolesc Psychiatry
Relation of heart rate at rest and long-term (>20 years) death rate in initially healthy middle-aged men
Am J Cardiol
Resting heart rate in cardiovascular disease
J Am Coll Cardiol
Chest pain in children and adolescents
Pediatr Clin North Am
Diversity of views from Europe on national pre-participation screening for competitive athletes
Heart Rhythm
National estimates and factors associated with medication treatment for childhood ADHD
Pediatrics
Increasing prevalence of parent-reported ADHD among childrenāUnited States 2003ā2007
MMWR Morb Mort Wkly Rep
Treatment of ADHD: overview of the evidence
Pediatrics
Stimulants and sudden death: what is a physician to do?
Pediatrics
A scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing
Circulation
Cardiovascular monitoring and stimulant drugs for ADHD
Pediatrics
Cardiovascular responses of hyperactive children to methylphenidate
JAMA
Relative cardiovascular safety of psychostimulants used to treat ADHD
J Child Adolesc Psychopharmacol
Cardiovascular effects of methylphenidate, amphetamines, and atomoxetine in the treatment of ADHD
Drug Saf
Cardiovascular effects of methylphenidate in humans are associated with increases of dopamine in brain and of epinephrine in plasma
Psychopharmacology
Needle in a haystack: modeling the incidence of sudden cardiac arrest in healthy children
Circulation
Cardiovascular effects of medications for the treatment of attention-deficit hyperactivity disorder: what is known and how should it influence prescribing in children?
Paediatr Drugs
Stimulant treatment of ADHD and risk of sudden death in children
Am J Psychiatry
Trends in medication treatment for ADHD
J Atten Disord
High blood pressure trends in children and adolescents in national surveys, 1963 to 2002
Circulation
Cardiovascular health in childhoodA statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association
Circulation
Stimulant drug therapy for ADHD and sudden cardiac death
Pediatrics
American Academy of Pediatrics/American Heart Association Clarification of Statement on Cardiovascular Evaluation and Monitoring of Children and Adolescents with Heart Disease Receiving Medications for ADHDMedia advisory
Cardiac risk assessment before the use of stimulant medications in children and youth
Pediatr Child Health
A dose-response and time-action analysis of autonomic and behavioral effects of methylphenidate in attention deficit disorder with hyperactivity
Psychophysiology
Attention deficit disorder and methylphenidate: a multi-step analysis of dose-response effects on children's cardiovascular functioning
Int Clin Psychopharmacol
Dose-response effects of methylphenidate on academic performance and overt behavior in hyperactive children
Pediatrics
Recent developments and strategies in pediatric pharmacology research in the USA
Child Adolesc Psychiatry Ment Health
A randomized, double-blind, crossover study of once-daily dexmethylphenidate in children with ADHD: rapid onset of effect
CNS Drugs
A double-blind, placebo-controlled study of modified-release methylphenidate in children with attention-deficit/hyperactivity disorder
Pediatrics
Efficacy of two long-acting methylphenidate formulations in children with ADHD in a laboratory classroom setting
J Child Adolesc Psychopharmacol
Efficacy and safety of dexmethylphenidate extended-release capsules administered once daily to children with attention-deficit/hyperactivity disorder
J Child Adolesc Psychopharmacol
A dose-response study of OROS methylphenidate in children with attention-deficit/hyperactivity disorder
Pediatrics
Effects of once-daily osmotic-release methylphenidate on blood pressure and heart rate in children with attention-deficit/hyperactivity disorder: results from a one-year follow-up study
J Clin Psychopharmacol
Cited by (0)
Disclosure: Dr. Hammerness has participated in continuing medical education (CME) activities, professional talks, and/or writing supported by Ortho-McNeil Janssen and Shire. He has served on the advisory board for Shire. He has participated in research studies funded by Cephalon, Eli Lilly and Co., GlaxoSmithKline, Johnson and Johnson, McNeil, Merck, New River, Novartis, Ortho-McNeil Janssen, Pfizer, Shire, Takeda, and Elminda. He has received honoraria from commercial entities supporting the Massachusetts General Hospital Psychiatry Academy. Dr. Perrin has served as a consultant for Pfizer. Dr. Wilens has received grant support from Abbott, McNeil, Eli Lilly and Co., Nextwave, the National Institutes of Health (NIH)/National Institute of Drug Abuse, Merck, and Shire. He has served on the speakers' bureau for Abbott, AstraZeneca, McNeil, Eli Lilly and Co., Nextwave, NIH, Novartis, Merck, and Shire. He receives royalties from Guilford Press. Ms. Shelley-Abrahamson reports no biomedical financial interests or potential conflicts of interest.