Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-20T04:26:58.916Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiovascular considerations of attention deficit hyperactivity disorder medications: a report of the European Network on Hyperactivity Disorders work group, European Attention Deficit Hyperactivity Disorder Guidelines Group on attention deficit hyperactivity disorder drug safety meeting

Published online by Cambridge University Press:  19 July 2011

Robert M. Hamilton ,
Eric Rosenthal ,
Martin Hulpke-Wette ,
John G. I. Graham  and
Joseph Sergeant
Robert M. Hamilton*
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Ontario, Canada
Eric Rosenthal
Affiliation:
Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom
Martin Hulpke-Wette
Affiliation:
Department of Pediatric Cardiology, Georg August, University Hospital, Göttingen, Germany
John G. I. Graham
Affiliation:
Child and Adolescent Psychiatry, University of Dundee, United Kingdom
Joseph Sergeant
Affiliation:
Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands
*
Correspondence to: Dr R. M. Hamilton, MD, FRCPC, Division of Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Tel: (416) 813-6142; Fax: (416) 813-7547; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Regulatory decisions regarding attention deficit hyperactivity disorder drug licensing and labelling, along with recent statements from professional associations, raise questions of practice regarding the evaluation and treatment of patients with attention deficit hyperactivity disorder. To address these issues for the European community, the European Network for Hyperkinetic Disorders, through its European Attention Deficit Hyperactivity Disorder Guidelines Group, organised a meeting between attention deficit hyperactivity disorder specialists, paediatric cardiovascular specialists, and representatives of the major market authorisation holders for attention deficit hyperactivity disorder medications. This manuscript represents their consensus on cardiovascular aspects of attention deficit hyperactivity disorder medications. Although sudden death has been identified in multiple young individuals on attention deficit hyperactivity disorder medication causing regulatory concern, when analysed for exposure using currently available data, sudden death does not appear to exceed that of the general population. There is no current evidence to suggest an incremental benefit to electrocardiography assessment of the general attention deficit hyperactivity disorder patient. Congenital heart disease patients have an increased prevalence of attention deficit hyperactivity disorder, and can benefit from attention deficit hyperactivity disorder therapies, including medication. The attention deficit hyperactivity disorder specialist is the appropriate individual to evaluate benefit and risk and recommend therapy in all patients, although discussion with a heart specialist is reasonable for congenital heart disease patients. For attention deficit hyperactivity disorder patients with suspected heart disease or risk factor/s for sudden death, assessment by a heart specialist is recommended, as would also be the case for a non-attention deficit hyperactivity disorder patient. The identification of risk factors for sudden death should not automatically exclude the use of attention deficit hyperactivity disorder medication.

Keywords

Attention deficit hyperactivity disorderstimulantsudden deathheart diseasecongenitaldrug therapyguidelines
Type
Original Articles
Information
Cardiology in the Young , Volume 22 , Issue 1 , February 2012 , pp. 63 - 70
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Goldman, LS, Genel, M, Bezman, RJ, Slanetz, PJ. Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association. J Am Med Asoc 1998; 279: 1100–1107.CrossRefGoogle ScholarPubMed
2. Meltzer, H, Gatward, R, Goodman, R, et al. Mental Health of Children and Adolescents in Great Britain. The Stationery Office, London, 2000.CrossRefGoogle Scholar
3. Hechtman, L, Greenfield, B. Long-term use of stimulants in children with attention deficit hyperactivity disorder: safety, efficacy, and long-term outcome. Paediatr Drugs 2003; 5: 787–794.CrossRefGoogle ScholarPubMed
4. American Academy of Pediatrics SoA-DHD. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108: 1033–1044.CrossRefGoogle Scholar
5. Vetter, VL, Elia, J, Erickson, C, et al. Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs: 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 2008; 117: 2407–2423.CrossRefGoogle Scholar
6. 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 ADHD: May 16, 2008. J Dev Behav Pediatr 2008; 29: 335.CrossRefGoogle Scholar
7. Disorders ENoH. EUNETHYDIS ADHD Drug Safety Meeting. Paper presented at EUNETHYDIS ADHD Drug Safety Meeting, 10–13 March, 2009, Zurich.Google Scholar
8. Berger, S, Kugler, JD, Thomas, JA, Friedberg, DZ. Sudden cardiac death in children and adolescents: introduction and overview. Pediatr Clin North Am 2004; 51: 1201–1209.CrossRefGoogle ScholarPubMed
9. Corrado, D, Basso, C, Schiavon, M, Thiene, G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998; 339: 364–369.CrossRefGoogle ScholarPubMed
10. Neuspiel, DR, Kuller, LH. Sudden and unexpected natural death in childhood and adolescence. J Am Med Assoc 1985; 254: 1321–1325.CrossRefGoogle ScholarPubMed
11. Rappley, MD, Moore, JW, Dokken, D. ADHD drugs and cardiovascular risk. N Engl J Med 2006; 354: 2296–2298; author reply 2296–2298.Google ScholarPubMed
12. Wren, C. Sudden death in children and adolescents. Heart 2000; 83: 410–413.CrossRefGoogle ScholarPubMed
13. Silka, MJ, Hardy, BG, Menashe, VD, Morris, CD. A population-based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects. J Am Coll Cardiol 1998; 32: 245–251.CrossRefGoogle ScholarPubMed
14. Sayal, K. Epidemiology of attention-deficit/hyperactivity disorder in the community. Br J Hosp Med (Lond) 2007; 68: 352–355.CrossRefGoogle ScholarPubMed
15. Hovels-Gurich, HH, Konrad, K, Skorzenski, D, et al. Long-term neurodevelopmental outcome and exercise capacity after corrective surgery for tetralogy of Fallot or ventricular septal defect in infancy. Ann Thorac Surg 2006; 81: 958–966.CrossRefGoogle ScholarPubMed
16. Shillingford, AJ, Glanzman, MM, Ittenbach, RF, Clancy, RR, Gaynor, JW, Wernovsky, G. Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease. Pediatrics 2008; 121: e759–e767.CrossRefGoogle Scholar
17. Winterstein, AG, Gerhard, T, Shuster, J, Johnson, M, Zito, JM, Saidi, A. Cardiac safety of central nervous system stimulants in children and adolescents with attention-deficit/hyperactivity disorder. Pediatrics 2007; 120: e1494–e1501.CrossRefGoogle ScholarPubMed
18. Gould, MS, Walsh, BT, Munfakh, JL, et al. Sudden death and use of stimulant medications in youths. Am J Psychiatry 2009; 166: 992–1001.CrossRefGoogle ScholarPubMed
19. Kuehn, BM. Stimulant use linked to sudden death in children without heart problems. J Am Med Assoc 2009; 302: 613–614.CrossRefGoogle ScholarPubMed
20. Schelleman, H, Bilker, WB, Strom, BL, et al. Cardiovascular events and death in children exposed and unexposed to ADHD agents. Pediatrics 2011; 127: 1102–1110.CrossRefGoogle ScholarPubMed
21. Champeroux, P, Martel, E, Vannier, C, et al. The preclinical assessment of the risk for QT interval prolongation. Thérapie 2000; 55: 101–109.Google ScholarPubMed
22. Faber, TS, Zehender, M, Just, H. Drug-induced torsade de pointes. Incidence, management and prevention. Drug Saf 1994; 11: 463–476.CrossRefGoogle ScholarPubMed
23. Labellarte, MJ, Crosson, JE, Riddle, MA. The relevance of prolonged QTc measurement to pediatric psychopharmacology. J Am Acad Child Adolesc Psychiatry 2003; 42: 642–650.CrossRefGoogle ScholarPubMed
24. Reingardiene, D, Vilcinskaite, J. QTc-prolonging drugs and the risk of sudden death. Medicina (Kaunas) 2007; 43: 347–353.CrossRefGoogle ScholarPubMed
25. Wernicke, JF, Faries, D, Girod, D, et al. Cardiovascular effects of atomoxetine in children, adolescents, and adults. Drug Saf 2003; 26: 729–740.CrossRefGoogle ScholarPubMed
26. Wernicke, JF, Kratochvil, CJ. Safety profile of atomoxetine in the treatment of children and adolescents with ADHD. J Clin Psychiatry 2002; 63 (Suppl 12): 50–55.Google ScholarPubMed
27. Fuller, CM. Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc 2000; 32: 887–890.CrossRefGoogle ScholarPubMed
28. Denchev, P, Kaltman, JR, Schoenbaum, M, Vitiello, B. Modeled economic evaluation of alternative strategies to reduce sudden cardiac death among children treated for attention deficit/hyperactivity disorder. Circulation 2010; 121: 1329–1337.CrossRefGoogle ScholarPubMed
29. Tanaka, Y, Yoshinaga, M, Anan, R, et al. Usefulness and cost effectiveness of cardiovascular screening of young adolescents. Med Sci Sports Exerc 2006; 38: 2–6.CrossRefGoogle ScholarPubMed
30. Corrado, D, Basso, C, Pavei, A, Michieli, P, Schiavon, M, Thiene, G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. J Am Med Assoc 2006; 296: 1593–1601.CrossRefGoogle ScholarPubMed
31. Ubel, PA, DeKay, ML, Baron, J, Asch, DA. Cost-effectiveness analysis in a setting of budget constraints – is it equitable? N Engl J Med 1996; 334: 1174–1177.CrossRefGoogle Scholar
32. Findling, RL, Short, EJ, Manos, MJ. Short-term cardiovascular effects of methylphenidate and adderall. J Am Acad Child Adolesc Psychiatry 2001; 40: 525–529.CrossRefGoogle ScholarPubMed
33. Samuels, JA, Franco, K, Wan, F, Sorof, JM. Effect of stimulants on 24-h ambulatory blood pressure in children with ADHD: a double-blind, randomized, cross-over trial. Pediatr Nephrol 2006; 21: 92–95.CrossRefGoogle ScholarPubMed
34. European Medicines Agency%. Guideline on Clinical Investigation of Medicinal Products for the Treatment of Attention Deficit Hyperactivity Disorder (ADHD), 2009. European Medicine Agency, 2010. 7 Westferry Circus, Canary Wharf, London E14 4HB, UK.Google Scholar
35. Gutgesell, H, Atkins, D, Barst, R, et al. Cardiovascular monitoring of children and adolescents receiving psychotropic drugs: a statement for healthcare professionals from the Committee on Congenital Cardiac Defects, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1999; 99: 979–982.CrossRefGoogle Scholar
36. Spencer, TJ, Greenbaum, M, Ginsberg, LD, Murphy, WR. Safety and effectiveness of coadministration of guanfacine extended release and psychostimulants in children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2009; 19: 501–510.CrossRefGoogle ScholarPubMed
37. Lurbe, E, Cifkova, R, Cruickshank, JK, et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 2009; 27: 1719–1742.CrossRefGoogle ScholarPubMed