Evaluation of acute Cardiovascular effects of immediate-release Methylphenidate in children and adolescents with attention deficit Hyperactivity disorder

Abstract

Attention-deficit hyperactivity disorder is a frequent condition in children and often extends into adulthood. Use of immediate-release methylphenidate (MPH) has raised concerns about potential cardiovascular adverse effects within a few hours after administration. This study was carried out to investigate acute effects of MPH on electrocardiogram (ECG) in a pediatric population. A total of 54 consecutive patients with attention-deficit hyperactivity disorder (51 males and 3 females; mean age =12.14±2.6 years, range 6-19 years), receiving a new prescription of MPH, underwent a standard ECG 2 hours before and after the administration of MPH 10 mg per os. Basal and posttreatment ECG parameters, including mean QT (QT interval when corrected for heart rate [QTc]), QTc dispersion (QTd) interval duration, T-peak to T-end (TpTe) intervals, and TpTe/QT ratio were compared. Significant modifications of both QTc and QTd values were not found after drug administration. QTd fluctuated slightly from 25.7±9.3 milliseconds to 25.1±8.4 milliseconds; QTc varied from 407.6±12.4 milliseconds to 409.8±12.7 milliseconds. A significant variation in blood pressure (systolic blood pressure 105.4±10.3 vs 109.6±11.5; P0.05; diastolic blood pressure 59.2±7.1 vs 63.1±7.9; P0.05) was observed, but all the data were within normal range. Heart rate moved from 80.5±15.5 bpm to 87.7±18.8 bpm. No change in TpTe values was found, but a statistically significant increase in TpTe/QTc intervals was found with respect to basal values (0.207±0.02 milliseconds vs 0.214±0.02 milliseconds; P0.01). The findings of this study show no significant changes in ECG parameters. TpTe values can be an additional parameter to evaluate borderline cases.

Effects of Methylphenidate on Cognitive Function in Adults with Traumatic Brain Injury: A Meta-Analysis

“…Cardiovascular adverse effects of MPH had been a concern since it was first reported in 1958 [48]. MPH had a sympathomimetic property which could activate beta-adrenoreceptor on cardiac tissues [49]. However, elevated heart rate is a risk for major cardiovascular disease, and all of which could lead to death [50].…”

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

“…It was thus concluded that the drug played a role in the efficacy of treatment by providing autonomic balance in addition to its simple effects, and for this reason, it has been reported to be safe and is not associated with severe cardiovascular diseases, although it may increase the heart rate with long-term use. In a study carried out in children to evaluate acute effects at the second hour after methylphenidate treatment, no significant difference was observed in QT, QTc and QT dispersion duration in ECG (15).…”