Stimulant Drugs for ADHD Do Not Increase Heart Risk in Healthy Kids
Studies over the past several years have found conflicting evidence about an association between stimulant drugs used to treat ADHD, such as Ritalin, and the risk of cardiovascular events in children. The latest research, conducted at Vanderbilt University and published in the New England Journal of Medicine, finds that parents should be reassured that their child taking the medications have a very low risk of cardiovascular events such as stroke or heart attack.
Drugs like methylphenidate are central nervous system stimulants which affect brain chemicals that contribute to hyperactivity and impulse control. Because serious side effects can occur, such as a fast or irregular heartbeat and chest pain, they are often thought to increase the risk of cardiovascular events, including sudden death.
Dr. William Cooper MD MPH and colleagues conducted a retrospective study using data from four health plans – Tennessee Medicaid, Washington State Medicaid, Kaiser Permanente California, and OptumInsight Epidemiology. Over one million children and young adults aged 2 to 24 years were considered for the study. Computerized records between 1986 and 2005 were used.
Among those with current ADHD drug use (ie: methylphenidate, dexmethylphenidate, dextroamphetamines, amphetamine salts, atomoxetine, and pemoline), there were 7 serious cardiovascular events compared to 25 in former users and 49 events among non-users. Although the upper limits of the 95% confidence intervals “indicated that doubling of the risk couldn’t be ruled out,” the absolute magnitude of such an increased risk would still be low.
The US Food and Drug Administration (FDA) does not currently recommend a warning label for the ADHD medications, but has stated that clinicians should continue to prescribe these drugs “taking special note that stimulant products and atomoxetine (brand name Strattera) should generally not be used in patients with serious heart problems or for whom an increase in blood pressure or heart rate would be problematic.”
In 2008, the American Heart Association recommended that children taking stimulant drugs for ADHD be given careful cardiac evaluation and monitoring, including an electrocardiogram, prior to treatment. The FDA also recommends that patients be periodically monitored for changes in heart rate or blood pressure.
About 2.7 million US children each year are prescribed stimulant drugs such as Ritalin and Strattera for ADHD. The Vanderbilt study is the first of three “separate but related” studies that are being conducted, sponsored in part by the Agency for Healthcare Research and Quality (AHRQ).
Cooper WO, et al "ADHD drugs and serious cardiovascular events in children and young adults" N Engl J Med 2011; DOI: 10.1056/NEJMoa1110212.