Early Cardiovascular Evaluation after Methylphenidate in Children with Attention-Deficit Hyperactivity Disorder

Abstract

Objective: Rare cardiovascular side effects may be observed in patients after treatment with methylphenidate for Attention Deficiency and Hyperactivity Disorder (ADHD). In this study, we aimed to evaluate the cardiac effects of methylphenidate before and after treatment in our center in children with ADHD. Method: This study included 253 ADHD patients who underwent methylphenidate treatment and involved a retrospective comparison of their demographic data, heart rate, systolic, diastolic blood pressure, corrected QT (QTc) interval with electrocardiography and echocardiographic examinations from before and two weeks after treatment. Results: The median age of the patients was 11.8 ± 3.3 years, palpitations were observed in 18 (7%) patients, and blood pressure elevation was observed in 5 (1.9%) patients after methylphenidate treatment. Sinus tachycardia was observed in all patients with palpitation symptoms, and echocardiography revealed an atrial septal defect in four patients, valvular pulmonary stenosis in two patients, ventricular septal defect and patent ductus arteriosus in one patient. No significant difference in heart rate, systolic and diastolic blood pressure values were identified after treatment. Although the QTc intervals recorded after treatment were significantly longer, these values did not exceed pathological levels. Conclusion:The findings of evaluations of children with ADHD after methylphenidate treatment vary according to the characteristics of the patients. Patients with structural heart disease or with arterial hypertension should be monitored more carefully before the use of methylphenidate in the diagnosis of ADHD. Our findings suggests that both blood pressure measurement and electrocardiographic assessment appear to be useful and appropriate in the detection of side effects after methylphenidate treatment.