Attention-deficit/hyperactivity disorder treatment: what are the long-term cardiovascular risks?

  title={Attention-deficit/hyperactivity disorder treatment: what are the long-term cardiovascular risks?},
  author={Paul G. Hammerness and Chris Karampahtsis and Ronke Babalola and Mark E Alexander},
  journal={Expert Opinion on Drug Safety},
  pages={543 - 551}
Introduction: This drug safety review provides an update on the long-term cardiovascular risks of therapeutic stimulant class medication for children and adults with attention-deficit/hyperactivity disorder (ADHD). Areas covered: Relevant literature on the long-term (defined as ≥ 12 months) cardiovascular effects of stimulant class medications for ADHD was sought using PubMed searches for clinical literature, epidemiological reports, as well as reviews of post-marketing data and clinical… 

Safety and Tolerability of Medications for ADHD

There is currently no proven association between ADHD medications and an increased risk of these events, and their incidence is extremely low.

Pediatric pharmacoepidemiology - safety and effectiveness of medicines for ADHD

Concerns exist about cardiovascular and psychiatric AEs, even if the available evidence does not support an association with medications, and effective drugs for ADHD appears to be safe and well tolerated.

An update on the safety of psychostimulants for the treatment of attention-deficit/hyperactivity disorder

Although methylphenidate has a well-established evidence base for treating ADHD, its long-term benefits are unclear and much less is known about longer-term efficacy and safety of these drugs.

Challenges and Promises of Pediatric Psychopharmacology.

The Safety of Atomoxetine for the Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Comprehensive Review of Over a Decade of Research

A comprehensive review of publications that addressed one or more of seven major safety topics relevant to atomoxetine treatment of children and adolescents diagnosed with ADHD found 15 papers about suicidality, three about aggression/hostility, seven about psychosis/mania, and six about seizures.

Effects of Long-Term Use of Prescription Methylphenidate on Myocardial Performance in Children with Attention-Deficit/Hyperactivity Disorder: A Tissue Doppler Imaging Study.

It is concluded that MPH use in children does not impair cardiovascular functions at short-term follow-up and the echocardiographic parameters measured resulted in no clinical difference between the children using MPH and the healthy controls.

The Mechanism, Clinical Efficacy, Safety, and Dosage Regimen of Atomoxetine for ADHD Therapy in Children: A Narrative Review

This review sets the focus on the mechanism, clinical efficacy and dosage regimen in detail, and also touches on those studies regarding adverse reactions of atomoxetine.

Adult ADHD and Comorbid Somatic Disease: A Systematic Literature Review

There are few large systematic studies using standardized diagnostic criteria evaluating adult ADHD and somatic comorbidities, and significant associations are found betweenadult ADHD and several somatic diseases.

JM-JABF210172 1074..1081

Prescription stimulant use has accelerated in the United States in recent years with a nearly 6fold increase in prescriptions since 1993, and a doubling from 2006 to 2016, but the majority are prescribed for attention-deficit hyperactivity disorder (ADHD).

Use of drugs for ADHD among adults—a multinational study among 15.8 million adults in the Nordic countries

Use of ADHD drug among adults more than doubled over a 5-year period, and a majority were concurrently treated with other psychotropics, most frequently antidepressants and hypnotics.



Cardiovascular Effects of Medications for the Treatment of Attention-Deficit Hyperactivity Disorder

It seems that the prescribing of ADHD medications in children should remain unchanged, when the very common and serious consequences from untreated ADHD are also considered in the assessment of risks and benefits, even in the presence of cardiac pathology.

Attention-Deficit/Hyperactivity Disorder, Stimulant Therapy, and the Patient with Congenital Heart Disease: Evidence and Reason

This review summarizes the current literature on the cardiovascular risks associated with the use of pharmacologic therapy for ADHD, with an emphasis on patients who had CHD.

ADHD medications and risk of serious cardiovascular events in young and middle-aged adults.

Among young and middle-aged adults, current or new use of ADHD medications, compared with nonuse or remote use, was not associated with an increased risk of serious cardiovascular events.

Attention Deficit Hyperactivity Disorder Screening Electrocardiograms: A Community-Based Perspective

In this population, screening EKGs rarely resulted in management changes for patients taking or starting ADHD medications, and in this study, the experience as a community-based cardiology group was reviewed.

Cardiovascular safety of stimulants in children with attention-deficit/hyperactivity disorder: a nationwide prospective cohort study.

The results suggest a safety signal with an increased risk of cardiovascular disease associated with stimulant treatment in children and adolescents, even after adjusting for a number of potential confounders.

Two-year outcome of treatment with central stimulant medication in adult attention-deficit/hyperactivity disorder: a prospective study.

The long-term treatment outcome shows that stimulants are effective in adult ADHD and side effects tend to be mild.

Cardiac Safety of Central Nervous System Stimulants in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

More evidence is needed that addresses the long-term risk/benefit of the various treatment options and the effect of other cardiac risk factors and comedications and no increased risk was found for periods of former use when compared with nonuse.

Relative cardiovascular safety of psychostimulants used to treat attention-deficit hyperactivity disorder.

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It probably is not essential to monitor heart rate, blood pressure, or EKG prior to or during routine psychostimulant treatment of children and adolescents with ADHD, unless there are comorbid cardiovascular abnormalities.

Stimulant medications and attention deficit-hyperactivity disorder.

To explore this issue, adverse events from stimulant medications prescribed for the treatment of ADHD were examined using data from the National Electronic Injury Surveillance.