Skip to main content
SpringerLink
Log in

Cardiovascular Safety of Stimulants in Children: Findings from Recent Population-Based Cohort Studies

  • Attention-Deficit Disorder (R Bussing, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

The past decade has seen a heated debate over the cardiac safety of central nervous system stimulants in the treatment of ADHD. This review discusses five controlled population-based studies that investigated this risk in children in the United States. All studies utilized administrative claims data of private or public insurance to compare risk of stimulant use to non-use. Two studies with smaller sample size lacked the ability to investigate serious events but report a slightly increased risk of emergency department visits attributed to cardiac symptoms such as tachycardia or palpitation. Three studies that enrolled more than one million patients found no association between stimulants and composite endpoints of sudden cardiac death, myocardial infarction, stroke and ventricular arrhythmia. The studies concur that background rates of serious cardiovascular events in children are extremely small. No study exceeded an average follow-up of two years, prohibiting inferences about long-term effects of stimulants.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. (CDC) Center for Disease Control and Prevention. Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children—United States, 2003 and 2007. MMWR Morb Mortal Wkly Rep. 2010;59(44):1439–43.

    Google Scholar 

  2. Nissen SE. ADHD drugs and cardiovascular risk. N Engl J Med. 2006;354(14):1445–8.

    Article  PubMed  CAS  Google Scholar 

  3. Osterweil N. FDA Pediatric advisers say nay to ADHD drug black box. MedPage Today 2006; http://www.medpagetoday.com/Psychiatry/ADHD-ADD/2921. Accessed 30 March 2013.

  4. Biederman J, Mick E, Surman C, et al. A randomized, placebo-controlled trial of OROS methylphenidate in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2006;59(9):829–35.

    Article  PubMed  CAS  Google Scholar 

  5. Weisler RH, Biederman J, Spencer TJ, Wilens TE. Long-term cardiovascular effects of mixed amphetamine salts extended release in adults with ADHD. CNS Spectr. 2005;10(12 Suppl 20):35–43.

    PubMed  Google Scholar 

  6. Samuels JA, Franco K, Wan F, Sorof JM. Effect of stimulants on 24-h ambulatory blood pressure in children with ADHD: a double-blind, randomized, cross-over trial. Pediatr Nephrol. 2006;21(1):92–5.

    Article  PubMed  Google Scholar 

  7. Stowe CD, Gardner SF, Gist CC, Schulz EG, Wells TG. 24-hour ambulatory blood pressure monitoring in male children receiving stimulant therapy. Ann Pharmacother. 2002;36(7–8):1142–9.

    Article  PubMed  CAS  Google Scholar 

  8. Findling RL, Short EJ, Manos MJ. Short-term cardiovascular effects of methylphenidate and adderall. J Am Acad Child Adolesc Psychiatry. 2001;40(5):525–9.

    Article  PubMed  CAS  Google Scholar 

  9. Kernan WN, Viscoli CM, Brass LM, et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med. 2000;343(25):1826–32.

    Article  PubMed  CAS  Google Scholar 

  10. Winterstein AG, Gerhard T, Shuster J, Johnson M, Zito JM, Saidi A. Cardiac safety of central nervous system stimulants in children and adolescents with attention-deficit/hyperactivity disorder. Pediatrics. 2007;120(6):e1494–1501.

    Article  PubMed  Google Scholar 

  11. Winterstein AG, Gerhard T, Shuster J, Saidi A. Cardiac safety of methylphenidate versus amphetamine salts in the treatment of ADHD. Pediatrics. 2009;124(1):e75–80.

    Article  PubMed  Google Scholar 

  12. Schelleman H, Bilker WB, Strom BL, et al. Cardiovascular events and death in children exposed and unexposed to ADHD agents. Pediatrics. 2011;127(6):1102–10.

    Article  PubMed  Google Scholar 

  13. Olfson M, Huang C, Gerhard T, et al. Stimulants and cardiovascular events in youth with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2012.

  14. Cooper WO, Habel LA, Sox CM, et al. ADHD drugs and serious cardiovascular events in children and young adults. N Engl J Med. 2011;365(20):1896–904.

    Article  PubMed  CAS  Google Scholar 

  15. Winterstein AG, Gerhard T, Kubilis P, et al. Cardiovascular safety of central nervous system stimulants in children and adolescents: population based cohort study. BMJ. 2012;345:e4627.

    Article  PubMed  Google Scholar 

  16. Guidance for industry: Diabetes mellitus—evaluating cardiovascular risk in new antidiabetic therapies to treat type 2 diabetes. Silver Spring, MD2008.

  17. Umana E, Solares CA, Alpert MA. Tachycardia-induced cardiomyopathy. Am J Med. 2003;114(1):51–5.

    Article  PubMed  Google Scholar 

  18. El Hajjar M, Hermida JS, Caron FM, Nassif D, Bourges-Petit E, Maingourd Y. Tachycardia-induced cardiomyopathy in children: a difficult diagnosis but a reversible form of left ventricular dysfunction. Arch Pediatr. 2004;11(1):24–8.

    Article  PubMed  Google Scholar 

  19. Shinbane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM. Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol. 1997;29(4):709–15.

    Article  PubMed  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Almut G. Winterstein has received research funding for stimulant safety studies from the Agency for Healthcare Research and Quality (AHRQ) and the Florida Agency for Health Care Administration/Medicaid. She was invited to present respective findings at the World ADHD Conference 2013 in Milan and received travel support from the organizers of the conference.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Author information

Authors and Affiliations

  1. Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32611, USA

    Almut G. Winterstein

  2. Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, 2004 Mowry Road, Gainesville, FL, 32611, USA

    Almut G. Winterstein

Authors
  1. Almut G. Winterstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Almut G. Winterstein.

Additional information

This article is part of the Topical Collection on Attention-Deficit Disorder

Rights and permissions

Reprints and permissions

About this article

Cite this article

Winterstein, A.G. Cardiovascular Safety of Stimulants in Children: Findings from Recent Population-Based Cohort Studies. Curr Psychiatry Rep 15, 379 (2013). https://doi.org/10.1007/s11920-013-0379-y

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-013-0379-y

Keywords

Search

Navigation