ADHD medication linked to slightly increased risk of heart rhythm problems

May 31, 2016

Use of methylphenidate in children and young people with ADHD is associated with a slightly increased risk of abnormal heart rhythm (arrhythmia) shortly after the start of treatment, suggests research published by The BMJ today.

Though the absolute risk is likely to be low, the researchers say the benefits of "should be carefully weighed against the potential cardiovascular risks of these drugs in and adolescents."

Methylphenidate is a central nervous system stimulant used to treat attention deficit hyperactivity disorder (ADHD), and narcolepsy. It is sold under various trade names, Ritalin being one of the most commonly known.

The cardiac safety of stimulants, which are known to slightly raise blood pressure and accelerate the heart rate, has been hotly debated, but the evidence is conflicting.

So a team of researchers based in Australia, Canada and South Korea set out to measure the cardiac safety of methylphenidate in children and with ADHD.

Using the South Korea National Health Insurance Database, they extracted data on 1,224 from a population of 114,647 children and young people aged 17 or younger and newly treated with methylphenidate at any time from 2008 to 2011.

Cardiac events included heart rhythm problems (arrhythmias), high blood pressure (hypertension), heart attacks (myocardial infarction), , and heart failure.

Cases of arrhythmia were statistically significantly more likely to have occurred during the first two months of use compared with periods of non-use, and risk was highest in the first three days of use.

The risk was more pronounced in children with existing congenital heart disease.

No significant risk of myocardial infarction was observed, though risk increased after the first week of treatment and remained raised for the first two months of continuous treatment.

No increased risk was observed for hypertension, ischemic stroke, or failure.

The authors point out that this is an observational study so no firm conclusions can be drawn about cause and effect - and that their findings should be interpreted with caution. However, the results prompt them to suggest that methylphenidate use might "trigger" the occurrence of arrhythmia in individual patients.

"Methylphenidate exposure in children and young people with diagnosis of ADHD is associated with arrhythmia and potentially with in specific time periods of use," they write. "With the increased use of drugs for ADHD globally, the benefits of methylphenidate should be carefully weighed against the potential cardiovascular risks of these drugs in children and adolescents."

In a linked editorial, John Jackson, a research fellow at Harvard School of Public Health in Boston, says it is difficult to describe the absolute risk in this type of study, but in the average child, the risk of serious cardiovascular events is extremely small (3 per 100,000 per year) and any absolute increase associated with methylphenidate is also likely to be small.

And he points out that regulatory labeling and treatment guidelines for stimulants recommend caution using these drugs in children with personal or familial history of cardiovascular disease and call for routine monitoring of .

"This study underscores the need to consider the severity of ADHD symptoms and the option of non-stimulants for children with high cardiovascular risk and to closely monitor patients for whom stimulants are critical for their wellbeing and development," he concludes.

Explore further: Stimulant treatment for ADHD not associated with increased risk of cardiac events in youth

More information: Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study: www.bmj.com/content/353/bmj.i2550

Editorial: The cardiovascular safety of methylphenidate: www.bmj.com/content/353/bmj.i2874

Related Stories

Stimulant treatment for ADHD not associated with increased risk of cardiac events in youth

February 8, 2012
Attention-deficit/hyperactivity disorder (ADHD) affects 5-9% of youth and is frequently treated with stimulant medications, such as methylphenidate and amphetamine products. A recent safety communication from the US Food ...

Stimulant meds safe, effective for children with ADHD and congenital heart disease

October 4, 2015
A new study finds that children with congenital heart disease and ADHD can take stimulant medications without fear of significant cardiovascular side effects.

Risk of drug abuse lower for teens prescribed stimulant medications early in life

April 27, 2016
Teens who take prescribed stimulant medications such as Ritalin, Adderall, Concerta and methylphenidate within a medical context early in life are at lower risk for developing substance use problems in adolescence, according ...

Researchers urge caution in prescribing commonly used drug to treat ADHD

November 25, 2015
Authors of new Cochrane Review remain uncertain about effect of widely used medicine on ADHD symptoms, despite large amount of research. Some evidence of increased sleeplessness and loss of appetite leads researchers to encourage ...

Methylphenidate 'normalizes' activation in key brain areas in kids with ADHD

May 9, 2013
The stimulant drug methylphenidate "normalizes" activation of several brain areas in young patients with attention-deficit/hyperactivity disorder (ADHD), according to a review published in the May Harvard Review of Psychiatry.

Does psychostimulant use increase cardiovascular risk in children with ADHD?

June 26, 2014
Psychostimulant use to treat children and adolescents with attention-deficit/hyperactivity disorder (ADHD) is increasing worldwide, and the evaluation of the cardiovascular safety of stimulant medication used in treatment ...

Recommended for you

ADHD medication tied to lower risk for alcohol, drug abuse in teens and adults

July 13, 2017
The use of medication to treat attention deficient hyperactivity disorder is linked to significantly lower risk for substance use problems in adolescents and adults with ADHD, according to a study led by researchers at Indiana ...

Video game promotes better attention skills in some children with sensory processing dysfunction

April 6, 2017
A video game under development as a medical device boosts attention in some children with sensory processing dysfunction, or SPD, a condition that can make the sound of a vacuum, or contact with a clothing tag intolerable ...

Children with ADHD often live in chaotic households

March 9, 2017
Researchers often observe inadequate parenting, a negative emotional climate and household chaos in families of children with ADHD. A research group at Goethe University Frankfurt and the universities of Bremen, Heidelberg, ...

ADHD a 'brain disorder', not just bad behaviour: study

February 16, 2017
People with ADHD have slightly smaller brains than those without the condition, according to a study released Thursday which insisted it is a physical disorder and not just bad behaviour.

Could the 'Mediterranean' diet help prevent ADHD?

January 30, 2017
(HealthDay)—Kids who follow a Mediterranean diet—high in fruits, vegetables and "good" fats—may be less likely to have attention deficit hyperactivity disorder (ADHD), a small study suggests.

Data scientists find causal relation in characteristics of ADHD

December 2, 2016
Hyperactivity seems to be the result of not being able to focus one's attention rather than the other way around. This was proposed in an article in PLOS ONE, written by researchers at Radboud university medical center and ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.