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[ADHD drugs and cardiovascular risk]
[Article in Dutch]
Langendijk PN,
Wilde AA.
Academisch Medisch Centrum/Universiteit van Amsterdam,
Postbus 22.660, 1100 DD Amsterdam.
Recently, the FDA recommended a black-box warning describing
the increased risk of cardiovascular events associated with
the use of stimulant drugs (amphetamines; in the Netherlands:
dexamphetamine, methylphenidate) in the treatment of
attention deficit hyperactivity disorder (ADHD). The
recommendation was based largely on the increased use of
these drugs in children and adults in the USA, voluntary
reporting of adverse events, and the pharmacological analogy
with other sympathomimetic amines, such as ephedrine,
pseudoephedrine and phenylpropanolamine, for which
similarwarnings have been given previously. The Adverse
Event Reporting System documented 25 cases of sudden death
based on WHO criteria with the use of amphetamines and
methylphenidate; most of the cases were children aged less
than 18 years. Sudden death in children is most often caused
by fatal arrhythmias due to congenital heart diseases, such
as long QT syndrome and hypertrophic cardiomyopathy. An
increase in heart rate can potentially provoke
life-threatening arrhythmias when the QT interval does not
compensate for the increase. In adults, increased blood
pressure and heart rate are well-documented risk factors for
cardiovascular events. The use of methylphenidate is
increasing in the Netherlands, indicating that greater
caution is warranted when prescribing these drugs.
PMID: 16924941 [PubMed - in process]
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Stimulants and sudden death:
what is a physician to do?
Wilens TE,
Prince JB,
Spencer TJ,
Biederman J.
Clinical Research Program in Pediatric
Psychopharmacology, Massachusetts General
Hospital, Harvard Medical School, Boston,
Massachusetts 02114, USA. twilens@partners.org
OBJECTIVE: Recently, a US Food and Drug
Administration advisory committee raised
concerns about cardiovascular risks and sudden
death in children and adolescents with
attention-deficit/hyperactivity disorder who are
receiving stimulants. METHODS: We comment on the
risk of sudden death in children/adolescents
taking stimulants compared with population
rates, biological plausibility, and known
cardiovascular effects of stimulants to
determine specific risk.
RESULTS: There does not seem to be higher
risk of sudden death in stimulant-treated
individuals compared with the general
population. Although there is evidence of
biological plausibility, the known effects of
the stimulants on cardiovascular
electrophysiology and vital signs seem to be
benign. CONCLUSIONS: There does not seem
to be compelling findings of a
medication-specific risk necessitating changes
in our stimulant treatment of children and
adolescents with attention-deficit/hyperactivity
disorder. The use of existing guidelines on the
use of stimulants (and psychotropic agents) may
identify children, adolescents, and adults who
are vulnerable to sudden death.
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