Cardiac Safety of Methylphenidate Versus Amphetamine Salts in the Treatment of ADHD
Open accessAbstract
OBJECTIVES: Safety concerns about central nervous system stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD) include adverse cardiac effects. This study aimed to compare the risk for cardiac events in users of methylphenidate and amphetamine salts. METHODS: A retrospective cohort design using claims data from the Florida Medicaid fee-for-service program representing a total of 2131953 children and adolescents was used. The analysis included all beneficiaries who were between 3 and 20 years of age, enrolled between July 1994 and June 2004, had at least 1 physician diagnosis of ADHD and were newly started on methylphenidate or amphetamine salts. Each month of follow-up was classified according to stimulant use into current use or former use. We defined cardiac events as first emergency department (ED) visit for cardiac disease or symptoms. Risk between current users of methylphenidate versus amphetamine salts and former users of drugs in these categories was compared by using a time-dependent Cox proportional hazard model that adjusted for differences in gender; race; age; year of the index date; disability; congenital anomalies; history of circulatory disease; history of hospital admission; and use of antidepressants, antipsychotics, and bronchodilators. RESULTS: A total of 456 youth visited the ED for cardiac reasons during 52783 years of follow-up. After adjustment for differences in covariates, the risk for cardiac ED visits was similar among current users of methylphenidate or amphetamines. Periods of former use had a similar risk between youth with an exposure history to methylphenidate or amphetamine. CONCLUSION: Exposure to methylphenidate and amphetamines salts showed similar risk for cardiac ED visits. Additional population-based studies that address manifestation of serious heart disease, especially after long-term use, dosage comparisons, and interactions with preexisting cardiac risk factors are needed to inform psychiatric treatment decisions.
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Common effects of stimulants on blood pressure, heart rate and exercise parameters are usually of no clinical significance.
“however, the common effects on blood pressure, heart rate and exercise parameters are usually of no clinical significance [55-57].”
From Advances in understanding and treating ADHD (2011) · cites this paper as [57]
A recent retrospective study concluded that exposure to methylphenidate and amfetamine salts showed similar risks for cardiac emergency department visits.
“A recent retrospective study concluded that exposure to methylphenidate and amfetamine salts showed similar risks for cardiac emergency department visits [158].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [158]
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Evaluating medication effects outside of clinical trials: new-user designs
Ray, W. A. (2003) · American Journal of Epidemiology · doi:10.1093/aje/kwg231 · Cited by 1,646 · see citing works
Efron, D., Jarman, F. C., & Barker, M. J. (1997) · PEDIATRICS · doi:10.1542/peds.100.4.662 · Cited by 301 · see citing works
Pelham, W. E., Aronoff, H. R., Midlam, J. K., Shapiro, C. J., Gnagy, E. M., Chronis, A. M., Onyango, A. N., Forehand, G. L., Nguyen, A. H., & Waxmonsky, J. G. (1999) · PEDIATRICS · doi:10.1542/peds.103.4.e43 · Cited by 198 · see citing works
King, S., Griffin, S. C., Hodges, Z., Weatherly, H. L. A., Asseburg, C., Richardson, G. A., Golder, S., Taylor, E., Drummond, M., & Riemsma, R. P. (2006) · Health Technology Assessment · doi:10.3310/hta10230 · Cited by 185 · see citing works
Long-Term Stimulant Medication Treatment of Attention-Deficit/Hyperactivity Disorder
Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., Leibson, C. L., & Jacobsen, S. J. (2014) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000099 · Cited by 153 · see citing works
Wilens, T. E., Hammerness, P. G., Biederman, J., Kwon, A., Spencer, T. J., Clark, S., Scott, M., Podolski, A., Ditterline, J., Morris, M. C., et al. (2005) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v66n0215 · Cited by 149 · see citing works
Samuels, J., Franco, K., Wan, F., & Sorof, J. M. (2005) · Pediatric Nephrology · doi:10.1007/s00467-005-2051-1 · Cited by 138 · see citing works
Pelham, W. E., Gnagy, E. M., Chronis, A. M., Burrows-MacLean, L., Fabiano, G. A., Onyango, A. N., Meichenbaum, D. L., Williams, A., Aronoff, H. R., & Steiner, R. L. (1999) · PEDIATRICS · doi:10.1542/peds.104.6.1300 · Cited by 138 · see citing works
Winterstein, A. G., Gerhard, T., Shuster, J. J., ZITO, J. M., Johnson, M. R., Liu, H., & Saidi, A. S. (2007) · Annals of Pharmacotherapy · doi:10.1345/aph.1k143 · Cited by 132 · see citing works
Self-citationLong-Term Stimulant Medication Treatment of Attention-Deficit/Hyperactivity Disorder
Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., Leibson, C. L., & Jacobsen, S. J. (2006) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/00004703-200602000-00001 · Cited by 125 · see citing works
Winterstein, A. G., Gerhard, T., Shuster, J., Johnson, M., Zito, J. M., & Saidi, A. (2007) · Pediatrics · doi:10.1542/peds.2007-0675 · Cited by 119 · see citing works
Self-citationShort- and Long-Term Cardiovascular Effects of Mixed Amphetamine Salts Extended Release in Children
Findling, R. L., Biederman, J., Wilens, T. E., Spencer, T. J., McGough, J. J., López, F. A., & Tulloch, S. J. (2005) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2005.03.014 · Cited by 84 · see citing works
Long-Term Cardiovascular Effects of Mixed Amphetamine Salts Extended Release in Adults With ADHD
Weisler, R. H., Biederman, J., Spencer, T. J., & Wilens, T. E. (2005) · CNS Spectrums · doi:10.1017/s109285290000242x · Cited by 68 · see citing works
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Faraone, S. V. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.02.001 · Cited by 631 · see citing works
ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults
Cooper, W. O., Habel, L. A., Sox, C. M., Chan, K. A., Arbogast, P. G., Cheetham, T. C., Murray, K. T., Quinn, V. P., Stein, C. M., Callahan, S. T., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1110212 · Cited by 411 · see citing works
European guidelines on managing adverse effects of medication for ADHD
(for the European Guidelines Group), Graham, J., Banaschewski, T., Buitelaar, J., Coghill, D., Danckaerts, M., Dittmann, R. W., Döpfner, M., Hamilton, R., Hollis, C., et al. (2011) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-010-0140-6 · Cited by 374 · see citing works
ADHD Medications and Risk of Serious Cardiovascular Events in Young and Middle-aged Adults
Habel, L. A., Cooper, W. O., Sox, C. M., Chan, K. A., Fireman, B. H., Arbogast, P. G., Cheetham, T. C., Quinn, V. P., Dublin, S., Boudreau, D. M., et al. (2011) · JAMA · doi:10.1001/jama.2011.1830 · Cited by 297 · see citing works
Advances in understanding and treating ADHD
Antshel, K. M., Hargrave, T. M., Simonescu, M., Kaul, P., Hendricks, K., & Faraone, S. V. (2011) · BMC Medicine · doi:10.1186/1741-7015-9-72 · Cited by 140 · see citing works
Dalsgaard, S., Kvist, A. P., Leckman, J. F., Nielsen, H. S., & Simonsen, M. (2014) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2014.0020 · Cited by 121 · see citing works
van de Loo-Neus, G. H. H., Rommelse, N., & Buitelaar, J. K. (2011) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2011.03.008 · Cited by 98 · see citing works
López, F. A., & Leroux, J. R. (2013) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-013-0106-x · Cited by 43 · see citing works
Cornforth, C., Sonuga-Barke, E., & Coghill, D. (2010) · Current Pharmaceutical Design · doi:10.2174/138161210791959827 · Cited by 41 · see citing works
- Authors
- Winterstein, A. G., Gerhard, T., Shuster, J., & Saidi, A.
- Affiliations
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy
- Rutgers, The State University of New Jersey (US)
- Department of Epidemiology, Biostatistics and Health Policy, General Clinical Research Center
- University of Florida (US)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2009-07-01
- Volume
- 124
- Issue
- 1
- Pages
- e75-e80
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC3856396
- OpenAlex
- W2156002863
- Cited by
- 56
- References
- 13
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2019: 1 · 2018: 3 · 2017: 1 · 2016: 2 · 2015: 3 · 2014: 5 · 2013: 4 · 2012: 10
- FWCI
- 6.78
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000064)
- Agency for Healthcare Research and Quality (U18HS016097)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- methylphenidate, amphetamine salts, attention deficit hyperactivity disorder, cardiac safety, psychostimulants, emergency department visits, pediatric drug use, Medicaid beneficiaries, children and adolescents
- MeSH terms
- Adolescent, Amphetamine, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Blood Pressure, Child, Child, Preschool, Female, Heart, Heart Rate, Humans, Male, Methylphenidate, Retrospective Studies, Proportional Hazards Models, Young Adult
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