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Visual Abstract
Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine.
Cardiovascular Effects of ADHD Medications: A Meta-Analysis
November 4, 2024
author
L Hennissen, MJ Bakker, T Banaschewski, S Carucci, D Coghill, M Danckaerts, RW Dittmann, C Hollis, H Kovshoff, S McCarthy, P Nagy, E Sonuga-Barke, IC Wong, A Zuddas, E Rosenthal, JK Buitelaar
journal
CNS Drugs
Date Published
2017-03
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Study Summary
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What They Studied
The study examined how stimulant and non-stimulant ADHD medications affect blood pressure and heart rate in children and adolescents.
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What They Found
They found that while methylphenidate affected only systolic blood pressure, amphetamines and atomoxetine increased blood pressure and heart rate.
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What This Means
The findings mean that current monitoring guidelines are essential as the increase in blood pressure and heart rate from these medications aligns with known risk factors for future cardiovascular issues.
Study Summary
Study Overview
This study sets out to explore how ADHD medications might affect cardiovascular health in young patients. It emphasizes monitoring due to the potential for small increases in blood pressure and heart rate that could have longer-term effects.
As ADHD medications are prescribed to children and adolescents, understanding these cardiovascular implications is crucial for safe clinical practices, particularly when managing patients with existing health concerns.
As ADHD medications are prescribed to children and adolescents, understanding these cardiovascular implications is crucial for safe clinical practices, particularly when managing patients with existing health concerns.
Abstract: background
To evaluate potential cardiovascular effects of these treatments, we conducted a systematic review and meta-analysis of the effects of methylphenidate (MPH), amphetamines (AMP), and atomoxetine (ATX) on diastolic and systolic blood pressure (DBP, SBP...more
Monitoring Importance
"The findings suggest that small, statistically significant increases in blood pressure and heart rate associated with ADHD medication may have implications for long-term cardiovascular health in affected patients."
Need for Awareness
"The clinical implications of this study underscore the need for heightened awareness among clinicians regarding potential cardiovascular effects when prescribing ADHD medication."
Risks of Treatment
"Identifying cardiovascular risks associated with ADHD medications is critical for safe clinical management, especially in pediatric populations who may be at risk of long-term health implications."
Study Summary
Methods
Researchers searched databases for studies involving ADHD patients up to 18 years old who were treated with methylphenidate, amphetamines, or atomoxetine. These studies measured key heart health indicators before and after treatment.
They included trials that were either open-label, where participants knew they were receiving the treatment, or double-blind, where neither participants nor researchers knew who received the treatment. They analyzed changes in heart function and assessed any potential heart rhythm issues.
They included trials that were either open-label, where participants knew they were receiving the treatment, or double-blind, where neither participants nor researchers knew who received the treatment. They analyzed changes in heart function and assessed any potential heart rhythm issues.
Abstract: methods
We conducted systematic searches in electronic databases (PsychINFO, EMBASE and Medline) to identify published trials which involved individuals who were (i) diagnosed with ADHD and were aged between 0-18 years; (ii) treated with MPH, AMP or ATX and ...more
Study Summary
Results
The analysis included 18 studies with 5,837 participants, mostly boys, treated over an average period of almost 29 weeks. It found slight increases in blood pressure with each medication, with methylphenidate affecting only systolic pressure, while amphetamines and atomoxetine affected both pressure types and heart rate.
Different medications showed no significant differences in how they affected cardiovascular health. However, age, gender, dose, and type of ADHD didn’t significantly change the results.
Different medications showed no significant differences in how they affected cardiovascular health. However, age, gender, dose, and type of ADHD didn’t significantly change the results.
Abstract: results
Eighteen clinical trials met the inclusion criteria (10 for MPH, 5 for AMP, and 7 for ATX) with data from 5837 participants (80.7% boys) and average duration of 28.7 weeks (range 4-96 weeks). All three medications were associated with a small, but st...more
Study Summary
Conclusions
ADHD medications like amphetamines and atomoxetine can increase blood pressure and heart rate in young patients, suggesting potential long-term heart risks. Methylphenidate was linked only to increases in systolic blood pressure.
Given these potential risks, it's critical for children taking these medications to have regular heart monitoring. Monitoring can ensure any significant changes in blood pressure or heart rate are detected early, helping prevent more serious heart issues later in life.
Given these potential risks, it's critical for children taking these medications to have regular heart monitoring. Monitoring can ensure any significant changes in blood pressure or heart rate are detected early, helping prevent more serious heart issues later in life.
Abstract: conclusions
Statistically significant pre-post increases of SBP, DBP and HR were associated with AMP and ATX treatment in children and adolescents with ADHD, while MPH treatment had a statistically significant effect only on SBP in these patients. These increase...more
Background Information
Patient Guide
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Stimulant Medications in ADHD Treatment
Methylphenidate and amphetamines are FDA-approved for ADHD, improving attention through neurotransmitter reuptake inhibition.
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Cardiovascular Monitoring Required
Regular cardiac evaluations needed for patients on ADHD medications due to risks of increased heart rate and blood pressure.
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Atomoxetine's Mechanism and Use
Atomoxetine is a norepinephrine reuptake inhibitor used for ADHD, impacting cardiovascular parameters.
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Adverse Cardiovascular Effects
ADHD meds may lead to cardiovascular events. Watch for symptoms like palpitations or arrhythmias.
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Clinical Practice and Monitoring
ADHD treatment requires careful CV monitoring and dose management to mitigate potential adverse effects.
Professional Guide
Expert Opinion: Cardiovascular Effects of ADHD Medications: A Meta-Analysis
In line with the systematic review's observations on cardiovascular effects, stimulant medications exhibit a mild yet consistent increase in blood pressure and heart rate, though clinical insignificance is noted for most patients.
Particularly for atomoxetine, caution is advised for those with existing cardiovascular conditions due to potential risks.
Professional guidelines recommend thorough cardiac assessments before initiating stimulant treatments and highlight the importance of monitoring for cardiovascular symptoms.
Particularly for atomoxetine, caution is advised for those with existing cardiovascular conditions due to potential risks.
Professional guidelines recommend thorough cardiac assessments before initiating stimulant treatments and highlight the importance of monitoring for cardiovascular symptoms.
Evidence Summary
Managing Sleep Disturbances from ADHD Medications
ADHD medications can have various impacts on sleep, often disrupting regular sleep patterns. Different medications may cause distinct effects, influencing how quickly someone falls asleep or their overall sleep quality.
To manage these issues, the article suggests practical steps like adjusting medication timing or establishing a bedtime routine, offering helpful insights for minimizing sleep disturbances linked to treatment.
Understanding each medication’s unique influence can help in making more informed choices.
To manage these issues, the article suggests practical steps like adjusting medication timing or establishing a bedtime routine, offering helpful insights for minimizing sleep disturbances linked to treatment.
Understanding each medication’s unique influence can help in making more informed choices.
Evidence Summary
Atomoxetine’s Potential for Reducing Hyperactivity in ASD
A pilot study examines whether atomoxetine could help reduce hyperactivity symptoms in individuals with Autism Spectrum Disorder (ASD). The research explores both the medication’s potential benefits and any safety concerns that may arise, aiming to find effective symptom management strategies.
The study’s focus is on assessing atomoxetine’s effectiveness in reducing hyperactivity while ensuring that it is safe for individuals with ASD. Results could open new options for managing symptoms associated with the disorder.
The study’s focus is on assessing atomoxetine’s effectiveness in reducing hyperactivity while ensuring that it is safe for individuals with ASD. Results could open new options for managing symptoms associated with the disorder.
Evidence Summary
Using Brain Scans to Guide Anxiety Treatment
Scientists are exploring whether brain scans can predict how well people with generalized anxiety disorder respond to specific medications. By using fMRI technology to observe brain activity changes in patients taking venlafaxine, researchers aim to see if certain patterns could help forecast treatment success.
This approach could offer doctors insights to tailor treatments more closely to individual patients, potentially improving outcomes for those with anxiety disorders.
This approach could offer doctors insights to tailor treatments more closely to individual patients, potentially improving outcomes for those with anxiety disorders.
