Early Cardiovascular Evaluation after Methylphenidate in Children with Attention-Deficit Hyperactivity Disorder

  • Erman Çilsal Adana City Hospital
  • Eray Yurtçu Kozan State Hospital
  • Aygül Elataş Adana City Hospital

Abstract

Objective: Rare cardiovascular side effects may be observed in patients after treatment with methylphenidate for Attention Deficiency and Hyperactivity Disorder (ADHD). In this study, we aimed to evaluate the cardiac effects of methylphenidate before and after treatment in our center in children with ADHD. Method: This study included 253 ADHD patients who underwent methylphenidate treatment and involved a retrospective comparison of their demographic data, heart rate, systolic, diastolic blood pressure, corrected QT (QTc) interval with electrocardiography and echocardiographic examinations from before and two weeks after treatment. Results: The median age of the patients was 11.8 ± 3.3 years, palpitations were observed in 18 (7%) patients, and blood pressure elevation was observed in 5 (1.9%) patients after methylphenidate treatment. Sinus tachycardia was observed in all patients with palpitation symptoms, and echocardiography revealed an atrial septal defect in four patients, valvular pulmonary stenosis in two patients, ventricular septal defect and patent ductus arteriosus in one patient. No significant difference in heart rate, systolic and diastolic blood pressure values were identified after treatment. Although the QTc intervals recorded after treatment were significantly longer, these values did not exceed pathological levels. Conclusion: The findings of evaluations of children with ADHD after methylphenidate treatment vary according to the characteristics of the patients. Patients with structural heart disease or with arterial hypertension should be monitored more carefully before the use of methylphenidate in the diagnosis of ADHD. Our findings suggests that both blood pressure measurement and electrocardiographic assessment appear to be useful and appropriate in the detection of side effects after methylphenidate treatment.

Author Biographies

Erman Çilsal, Adana City Hospital
Pediatric Cardiology Department
Eray Yurtçu, Kozan State Hospital
Department of Pediatrics
Aygül Elataş, Adana City Hospital
Department of Pediatrics

References

Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, Koretz DS (2010) Prevalence and treatment of mental disorders among US children in the 2001-2004 NHANES. Pediatrics 125: 75-81

Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, Perou R, Blumberg SJ (2014) Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. Journal of the American Academy of Child and Adolescent Psychiatry 53: 34-46 e32

Vahia VN (2013) Diagnostic and statistical manual of mental disorders 5: A quick glance. Indian J Psychiatry 55: 220-223

Subcommittee on Attention-Deficit/Hyperactivity D, Steering Committee on Quality I, Management, Wolraich M, Brown L, Brown RT, DuPaul G, Earls M, Feldman HM, Ganiats TG, Kaplanek B, Meyer B, Perrin J, Pierce K, Reiff M, Stein MT, Visser S (2011) ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 128: 1007-1022

Pliszka SR, Crismon ML, Hughes CW, Corners CK, Emslie GJ, Jensen PS, McCracken JT, Swanson JM, Lopez M, Texas Consensus Conference Panel on Pharmacotherapy of Childhood Attention Deficit Hyperactivity D (2006) The Texas Children's Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 45: 642-657

Storebo OJ, Ramstad E, Krogh HB, Nilausen TD, Skoog M, Holmskov M, Rosendal S, Groth C, Magnusson FL, Moreira-Maia CR, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbol B, Simonsen E, Gluud C (2015) Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). The Cochrane database of systematic reviews: CD009885

Nissen SE (2006) ADHD drugs and cardiovascular risk. The New England journal of medicine 354: 1445-1448

Winterstein AG, Gerhard T, Kubilis P, Saidi A, Linden S, Crystal S, Zito J, Shuster JJ, Olfson M (2012) Cardiovascular safety of central nervous system stimulants in children and adolescents: population based cohort study. Bmj 345: e4627

Schelleman H, Bilker WB, Strom BL, Kimmel SE, Newcomb C, Guevara JP, Daniel GW, Cziraky MJ, Hennessy S (2011) Cardiovascular events and death in children exposed and unexposed to ADHD agents. Pediatrics 127: 1102-1110

Batra AS, Alexander ME, Silka MJ (2012) Attention-deficit/hyperactivity disorder, stimulant therapy, and the patient with congenital heart disease: evidence and reason. Pediatr Cardiol 33: 394-401

Mick E, McManus DD, Goldberg RJ (2013) Meta-analysis of increased heart rate and blood pressure associated with CNS stimulant treatment of ADHD in adults. Eur Neuropsychopharmacol 23: 534-541

Cortese S, Holtmann M, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Graham J, Taylor E, Sergeant J, European AGG (2013) Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. J Child Psychol Psychiatry 54: 227-246

Hammerness P, Wilens T, Mick E, Spencer T, Doyle R, McCreary M, Becker J, Biederman J (2009) Cardiovascular effects of longer-term, high-dose OROS methylphenidate in adolescents with attention deficit hyperactivity disorder. J Pediatr 155: 84-89, 89 e81

Kim HJ, Yang J, Lee MS (2015) Changes of Heart Rate Variability during Methylphenidate Treatment in Attention-Deficit Hyperactivity Disorder Children: A 12-Week Prospective Study. Yonsei Med J 56: 1365-1371

Lamberti M, Italiano D, Guerriero L, D'Amico G, Siracusano R, Ingrassia M, Germano E, Calabro MP, Spina E, Gagliano A (2015) Evaluation of acute cardiovascular effects of immediate-release methylphenidate in children and adolescents with attention-deficit hyperactivity disorder. Neuropsychiatr Dis Treat 11: 1169-1174

Shin JY, Roughead EE, Park BJ, Pratt NL (2016) Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study. Bmj 353: i2550

Berg A, Bratane E, Odland HH, Brudvik C, Rosland B, Hirth A (2014) [Cardiovascular risk assessment for the use of ADHD drugs in children]. Tidsskr Nor Laegeforen 134: 710-714

Arcieri R, Germinario EA, Bonati M, Masi G, Zuddas A, Vella S, Chiarotti F, Panei P, Italian Attention-Deficit/Hyperactivity Disorder Regional Reference C (2012) Cardiovascular measures in children and adolescents with attention-deficit/hyperactivity disorder who are new users of methylphenidate and atomoxetine. Journal of child and adolescent psychopharmacology 22: 423-431

Published
2020-06-11
Section
Original Research