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Last Updated: Apr 22, 2008 - 9:52:31 AM |
TUESDAY April 22, 2008 (foodconsumer.org) -- The American Heart Association on April 21 issued a statement to recommend that children with attention deficit hyperactivity disorder (ADHD) should get careful assessment for their cardiac condition using an electrocardiogram (ECG) before treatment with stimulant drugs.
The recommendation is also valid for children who are currently receiving stimulant therapy, but have not received the cardiac evaluation. The AHA said side effects of ADHD drugs are insignificant, but they may have an impact on children with certain heart abnormalities.
The 18-page statement titled Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs was published online in Circulation: Journal of the American Heart Association.
According to the AHA, what drove the organization to issue such a statement are the concerns over potential cardiovascular effects of psychotropic drugs, especially tricyclic antidepressants. The concerns have emerged since 1999, but no specific cardiovascular monitoring with an ECG has been recommended for the use of stimulant medications. What also prompted the statement are warnings from the Food and Drug Administration about ADHD drugs and public concerns for the drug safety.
Stimulant medications used to treat ADHD have been known to increase heart rate and blood pressure, which could increase cardiac events. One study led by Samuels JA, Franco K, Wan F, Sorof JM. from The University of Texas Health Science Center at Houston reported in 2006 showed evidence for a possible negative cardiovascular effect of stimulant medications in children with ADHD. And the authors suggested that this potential cardiovascular risk should be balanced against the beneficial behavioral effects of this class of medication.
In their report published in Pediatr Nephrol. 2006 Jan;21(1):92-5. Epub 2005 Oct 28., they said children receiving stimulant therapy had significantly higher diastolic blood pressure and waking diastolic blood pressure during a 24-hour monitoring period. Both total heart rate and the rate-pressure product were also higher, meaning that using the ADHD drugs increases heart risk in pediatric patients.
Certain heart conditions such as erratic heart rhythm increase the risk for sudden cardiac death (SCD) and use of ADHD drugs have been associated with increased risk of sudden cardiac deaths. A report published in 2006 by Langendijk P. N. and Wilde A. A. from Academisch Medisch Centrum/Universiteit van Amsterdam showed that the U.S. Adverse Event Reporting System documented 25 cases of sudden death based on WHO criteria with the use of amphetamines and methylphenidate, stimulant drugs used to treat attention deficit hyperactivity disorder (ADHD). Most the cases were children aged less than 18 years.
The authors said sudden death in children is often caused by fatal arrhythmias due to congenital heart disease such as long QT syndrome and hypertrophic cardiomyopathy. The article was titled Medication for ADHD and the risk of cardiovascular mortality and published in the Aug 5, 2006 issue of Nederlands Tijdschrift voor Geneeskunde.
The AHA said doctors perform routine physical exams and review the patient and family history to determine the risk of health problems before starting new treatments, but such examinations are not sufficient to detect the cardiac conditions associated with SCD because many of these conditions do not result in symptoms and even if there is any the subtle symptoms such as palpitations, fainting or chest pain can be vague or elusive. But an ECG can have the job done.
Based on these arguments, the AHA recommends an ECG should be used to evaluate cardiac conditions in children with ADHD before any treatment with stimulant drugs. This can help doctors to identify heart rhythm abnormalities that could potentially lead to sudden cardiac death. The AHA receives donations from pharmaceutical firms and medical device manufacturers, the organization states on its website.
The authors for the statement said children who are found to have a heart condition should be referred to a pediatric cardiologist. Those who are deemed to have no problem and start taking ADHD drugs should be checked periodically for blood pressure within one to three months and then every six to 12 months. Further, if the initial ECG is taken before age 12, the statement says it may be useful to repeat the ECG test after the children is over 12 years.
Victoria L. Vetter, M.D at the University of Pennsylvania School of Medicine in Philadelphia, lead author of the statement, said 33 to 42 percent of pediatric cardiac patients have ADHD. Early surveys showed an estimated 4 to 12 percent of all school children suffered ADHD and about 2.5 million children took medications for the condition in 2003.
© 2004-2008 by foodconsumer.org unless otherwise specified
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