April 22, 2008 - Children Taking Medication For ADHD Need Heart Screening

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Children who have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) should be screened for heart problems before receiving prescription drugs such as Ritalin or Adderall, the American Heart Association has warned.

In the United States, approximately 2.5 million children and 1.5 million adults take either Ritalin, Adderall or Concerta - all stimulants - to control the symptoms of ADHD. A potential side effect of any stimulant is an increased heart rate, which can be dangerous or even deadly for a patient with an undetected heart problem.

Stimulants such as Adderall, Concerta and Ritalin are known to increase heart rate and raise blood pressure. In 2006, the FDA added a “black box” warning to the labels of ADHD drugs warning of the cardiovascular risks associated with the medications. The heart-related problems that are cited in the warning include sudden death in patients who have heart problems or heart defects; stroke and heart attack in adults; and increased blood pressure and heart rate.

Attention Deficit Hyperactivity Disorder is a condition that can become apparent as early as the preschool and early school years. It is difficult for children and adults with ADHD to control their behavior, pay attention and remain focused. An estimated 3 to 5 percent of American children have been diagnosed with ADHD.

Last December, the journal “Pediatrics” published a study suggesting that such medications cause heart-related symptoms. The study, which was conducted between 1994 and 2004, analyzed data on 55,383 Florida children ages 3 and up who had been diagnosed with ADHD. The children who were taking a prescription stimulant  to control their ADHD symptoms were found to be 20 percent more likely to visit an emergency clinic or doctor’s office with heart-related symptoms, as compared to those children who had never used or stopped using such medications. The rates of death and heart-related hospitalizations, however, were no higher than the national rates among the general population.

Despite what would appear to be reassuring news about stimulant-related deaths and serious heart conditions, the authors of the “Pediatrics” article assert that there is a great need for more long-term research on these drugs to determine the effects of chronic stimulant use during childhood on heart disease in adulthood.

The American Heart Association is now recommending that doctors conduct a thorough exam, including afamily history and an EKG, in order to rule out heart problems prior to placing children on ADHD medications. “We don’t want to keep children who have this from being treated. We want to do it assafely as possible.” said Dr. Victoria Vetter, a pediatric cardiologist at the University of Pennsylvania School of Medicine and head of the committee making the recommendation.

Children who are on ADHD drugs should be screened for heart problems, the AHA says, and with careful monitoring by a pediatric cardiologist, including regular EKG testing, which can detect the sort of abnormal heart rhythm that might lead to sudden cardiac arrest, even those children with heart problems can take the ADHD medications if necessary.

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