Screen for Kids for Heart Problems Before Prescribing ADHD Drugs, Heart Group SaysApr 22, 2008 | Parker Waichman LLP
Children with Attention Deficit Hyperactivity Disorder (ADHD) should be screened for heart problems before they are prescribed stimulant drugs like Ritalin, the American Heart Association has warned. About 2.5 million American children and 1.5 million adults take stimulants such as Ritalin, Adderall and Concerta to control the symptoms of ADHD. Such drugs are known to increase heart rates, a side effect that can be dangerous - and even deadly - if a patient has an undetected heart condition.
ADHD is a condition that becomes apparent in some children in the preschool and early school years. It is hard for these children to control their behavior and/or pay attention. It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. Stimulants, like Adderall and Ritalin, are known to raise blood pressure. In 2006, the FDA added a “black box” warning to the labels of ADHD drugs warning of cardiovascular risks associated with the medications. The heart-related problems cited by the new warning included sudden death in patients who have heart problems or heart defects; stroke and heart attack in adults; and increased blood pressure and heart rate.
Last December, the journal "Pediatrics" published a study that suggested such medications do cause some heart symptoms. The study that looked at data on 55,383 Florida children ages 3 to 20 years who had ADHD. About 59 percent were taking a stimulant medication during the study period (1994 to 2004). Children taking a stimulant to control ADHD symptoms were 20 percent more likely to visit an emergency clinic or doctor’s office with heart-related symptoms, such as a racing heartbeat, than children who had never used or discontinued treatment. However, rates of death or hospital admission for serious heart conditions were no different than the national rates among the general population.
Despite the apparent good news on serious heart conditions and deaths related to ADHD stimulants, the authors of the “Pediatrics” article asserted that there was a great need for more research on the long-term effects of these drugs. Given that 3 to 4 million children take stimulant medications like Ritalin to control symptoms of ADHD, they wrote that further studies need to be done to determine the consequences 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 a family history and an EKG, before children are put on the drugs to make sure that they don't have any undiagnosed heart issues. "We don't want to keep children who have this from being treated. We want to do it as safely 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.
An EKG can detect abnormal heart rhythms that can lead to sudden cardiac arrest. Children who are already on ADHD drugs should also be tested, the heart group said. With careful monitoring by a pediatric cardiologist, children with heart problems can take the medicines if necessary.