A cardiopulmonary study of lisdexamfetamine in adults with attention-deficit/hyperactivity disorder
Abstract
Objectives Due to concerns about the safety of stimulants for ADHD, novel assessments of the cardiopulmonary impact of these agents are needed. Methods An open design of lisdexamfetamine (LDX) in 15 adults with DSM-IV ADHD. Following a psychiatric evaluation and medical history, subjects underwent echocardiography (TTE) and cardiopulmonary exercise testing (CPET). LDX was titrated to 70 mg daily over 6 weeks, followed by monthly visits to 6 months. Change in TTE and CPET measures were examined following up to 6 months of LDX. Results At endpoint, there were no significant alterations in indices of cardiac systolic performance, or in metabolic and ventilatory variables at maximum exertion (P values >0.05). We found significant mean changes in resting LV systolic dimension and Doppler diastolic indices. Change in heart rate recovery at 1 min met statistical significance (P = 0.05). Conclusions We did not detect clinically meaningful changes in cardiac structure and function or in metabolic and ventilatory variables at maximum exertion in ADHD adults receiving open LDX. The clinical significance of changes in resting LV dimension and indices of diastolic function are not in the direction of cardiomyopathy. Future large sample controlled study can examine these findings, as well as stimulants' impact on heart rate recovery.
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A 6-month study of LDX titrated to 70 mg/d in 15 patients (aged 18-60) using comprehensive provocative physiological testing including resting transthoracic echocardiogram and noninvasive cardiopulmonary exercise testing did not find clinically meaningful changes in cardiac structure or function at rest or during peak exertion.
“A 6-month study where LDX was titrated to 70 mg/d in 15 patients (aged 18-60 years) used comprehensive, provocative physiological testing including resting transthoracic echocardiogram and noninvasive cardiopulmonary exercise testing and did not find clinically meaningful changes in cardiac structure or function at rest or during peak exertion.”
From Review of Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/Hyperactivity Disorder (2017) · cites this paper as [48]
Postmarketing safety data are consistent with earlier reported adverse events, and poison centers have reported patients presenting with insomnia, dystonia, hallucinations, jitters, tachycardia, and chest pain.
“Postmarketing safety data are consistent with the earlier reported adverse events, and poison centers have reported patients presenting with insomnia, dystonia, hallucinations, jitters, tachycardia, and chest pain.47”
From Review of Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/Hyperactivity Disorder (2017) · cites this paper as [47]
At maximum exertion, diastolic blood pressure was significantly increased in hypertensive patients (P < .003), but not in healthy subjects.
“At maximum exertion, diastolic blood pressure was significantly increased in hypertensive patients (P < .003), but not in healthy subjects, which may require further studies to elucidate the cause.”
From Review of Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/Hyperactivity Disorder (2017) · cites this paper as [48]
In that study, no significant mean changes in metabolic and ventricular variables were noted.
“Likewise, no significant mean changes in metabolic and ventricular variables were noted.48”
From Review of Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/Hyperactivity Disorder (2017) · cites this paper as [48]
In that study, a decrease in left ventricular dimensions was observed; however, a more sensitive measure of LV size, a change in LV volume, was not noted.
“A decrease in left ventricular (LV) dimensions was observed; however, a more sensitive measure of LV size, a change in LV volume, was not noted.”
From Review of Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/Hyperactivity Disorder (2017) · cites this paper as [48]
In that study, no changes were observed in oxygen uptake and oxygen pulse.
“No changes were observed in oxygen uptake (gold standard measure of cardiorespiratory fitness) and oxygen pulse (noninvasive estimate of stroke volume).”
From Review of Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/Hyperactivity Disorder (2017) · cites this paper as [48]
In Hammerness et al open-label study of 15 patients, transthoracic echocardiography and cardiopulmonary exercise testing showed changes in resting left ventricular systolic function and diastolic indices on treatment with lisdexamfetamine; however, these changes were not in the direction of cardiomyopathy and there were no major changes in cardiac function at maximal exertion.
“Transthoracic echocardiography and cardiopulmonary exercise testing showed changes in resting left ventricular systolic function and diastolic indices on treatment with lisdexamfetamine. However, these changes were not in the direction of cardiomyopathy and there were no major changes in cardiac function at maximal exertion.”
From Update on optimal use of lisdexamfetamine in the treatment of ADHD (2013) · cites this paper as [20]
In that study, heart rate recovery was elevated by 4 beats per minute.
“Interestingly, heart rate recovery was elevated by 4 beats per minute in this study.20”
From Update on optimal use of lisdexamfetamine in the treatment of ADHD (2013) · cites this paper as [20]
Cites
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
Towards Conceptualizing a Neural Systems-Based Anatomy of Attention-Deficit/Hyperactivity Disorder
Makris, N., Biederman, J., Monuteaux, M. C., & Seidman, L. J. (2009) · Developmental Neuroscience · doi:10.1159/000207492 · Cited by 178 · cited 1× · see citing works
“The current literature provides converging evidence that attention defi cit hyperactivity disorder (ADHD) is a valid clinical entity in adulthood (Spencer et al. 2008; Makris et al. 2009) occurring in 3–5% of adults worldwide (Kessler et al. 2006; Fayyad et al. 2007).”
BackgroundCardiovascular Monitoring and Stimulant Drugs for Attention-Deficit/Hyperactivity Disorder
Perrin, J. M., Friedman, R. A., Knilans, T. K., the Black Box Working Group, & Surgery, T. S. O. C. A. C. (2008) · Pediatrics · doi:10.1542/peds.2008-1573 · Cited by 161 · 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
Adler, L. A., Weisler, R. H., Goodman, D. W., Hamdani, M., & Niebler, G. E. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05335pur · Cited by 42 · cited 1× · see citing works
“…profi le, numerous, large controlled clinical trials of stimulants in healthy adults with ADHD have rarely identifi ed cardiovascular adverse effects outside of minor mean increases in blood pressure and heart rate (Biederman et al. 2007; Spencer et al. 2007; Wilens et al. 2005; Adler et al. 2009).”
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Update on optimal use of lisdexamfetamine in the treatment of ADHD
Madaan, V., Kolli, V., Bestha, D., & Shah, M. (2013) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s34092 · Cited by 19 · see citing works
“Interestingly, heart rate recovery was elevated by 4 beats per minute in this study.(20) Mora et al suggest that impaired heart rate recovery may be an indicator of cardiovascular risk.”
BackgroundReview of Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/Hyperactivity Disorder
Najib, J., Wimer, D., Zeng, J., Lam, K. W., Romanyak, N., Paige Morgan, E., & Thadavila, A. (2017) · Journal of Central Nervous System Disease · doi:10.1177/1179573517728090 · Cited by 17 · see citing works
- Authors
- Hammerness, P., Zusman, R., Systrom, D., Surman, C., Baggish, A., Schillinger, M., Shelley-Abrahamson, R., & Wilens, T. E.
- Affiliations
- Massachusetts General Hospital (US)
- Corresponding author
- Hammerness, Paul
- Venue
- The World Journal of Biological Psychiatry
- Publisher
- Informa UK Limited
- Published
- 2012-05-06
- Volume
- 14
- Issue
- 4
- Pages
- 299-306
- ISSN
- 1562-2975 (ISSN-L)
- 1814-1412
- OpenAlex
- W2106629104
- Cited by
- 15
- References
- 5
- Citations by year
- 2022: 2 · 2021: 1 · 2019: 1 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 2
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The World Journal of Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- lisdexamfetamine, attention deficit hyperactivity disorder, adult ADHD, cardiopulmonary effects, echocardiography, cardiopulmonary exercise testing, left ventricular diastolic function, heart rate recovery, cardiac systolic function, cardiomyopathy
- MeSH terms
- Lisdexamfetamine Dimesylate, Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Dextroamphetamine, Echocardiography, Exercise Test, Female, Heart, Heart Rate, Humans, Hypertension, Male, Middle Aged, Prospective Studies, Case-Control Studies
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