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Methylphenidate slightly increases cardiovascular risk among children
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Use of methylphenidate among children and adolescents for treatment of attention-deficit/hyperactivity disorder slightly increased the RR for cardiovascular events, such as myocardial infarction and arrhythmias, according to recent research in BMJ.
“Drugs to treat ADHD have been shown to be efficacious in reducing symptoms of impulsivity and hyperactivity in children, but concerns have been expressed about possible adverse cardiovascular events with the first-line treatment, methylphenidate,” Ju-Young Shin, PhD, of the departments of epidemiology, biostatistics and occupational health at McGill University, and colleagues wrote. “We explored whether methylphenidate use is a triggering factor among children who experience cardiovascular events — including arrhythmia, hypertension, myocardial infarction, ischemic stroke, or heart failure.”
The researchers studied a cohort of 1,224 children aged younger than 17 years who experienced a cardiovascular event and had at least one prescription for methylphenidate. The self-controlled case study was conducted using data from the South Korean national health insurance database, from 2008 through 2011. The researchers calculated incidence rate ratios to determine the RR for cardiovascular events among this population. Methylphenidate exposure time periods were defined as 1 to 3 days, 4 to 7 days, 8 to 14 days, 15 to 28 days, 29 to 56 days and longer than 56 days.
The risk for arrhythmia was increased across all exposure time periods — particularly during days 1 to 3 — with the greatest risk found among children with congenital heart disease. Risk for myocardial infarction was higher between 8 and 56 days of methylphenidate exposure; however, there was no significant risk across all exposure time periods. The researchers found no risk for hypertension overall.
“Methylphenidate exposure in children/young people with diagnosis of ADHD is associated with arrhythmia and potentially with myocardial infarction in specific time periods of use,” Shin and colleagues wrote. “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 related editorial, John W. Jackson, ScD, of the department of epidemiology at the Harvard T.H. Chan School of Public Health, noted that while the risk for children with congenital heart disease is significantly increased, the risk for serious cardiovascular events among average children is extremely small. Jackson said the absolute risk is likely to be small based on the research by Shin and colleagues.
“Regulatory labeling and treatment guidelines for stimulants express caution for use in children with personal or familial history of cardiovascular disease and call for routine monitoring of blood pressure,” Jackson wrote. “The study by Shin and colleagues underscores the need to consider the severity of ADHD symptoms and the option of nonstimulants for children with high cardiovascular risk, to avoid uses that are entirely off label, and to closely monitor patients for whom stimulants are critical for their well-being and development.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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