Methylphenidate and Risk of Serious Cardiovascular Events in Adults

Schelleman, Hedi; Bilker, Warren B.; Kimmel, Stephen E.; Daniel, Gregory W.; Newcomb, Craig; Guevara, James P.; Cziraky, Mark J.; Strom, Brian L.; Hennessy, Sean

doi:10.1176/appi.ajp.2011.11010125

Cited by 103 publications

(112 citation statements)

References 25 publications

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“…There are two separate clinical implication to our findings in the Tel Aviv MMT clinic: the 1st and most important one, is the need to develop a protocol of treatment for the ADHD MMT patients, taking into consideration both the problematic prescription of an addictive medication with severe abuse potential to patients with addictive disease and the potentially hazardous addition of a medication that induces (at least) tachycardia (methylphenidate) (Schelleman et al, 2012) to a medication known to potentially prolong the QTc on ECG (MMT) (Mujtaba, Romero, & Taub, 2013), blood pressure elevation and risk of prehypertension (Martinez-Raga, Knecht, Szerman, & Martinez, 2013;Westover, Nakonezny, Winhusen, Adinoff, & Vongpatanasin, 2013), marked decrease in appetite leading to significant weight loss and episodes of depression and paranoia (Imbert, Cohen, & Simon, 2013). The primary clinical syndrome of methylphenidate overdose involves prominent neurological and cardiovascular effects, while secondary complications can involve renal, muscle, pulmonary, and gastrointestinal effects.…”

Section: Discussionmentioning

confidence: 98%

Differences in Methylphenidate Abuse Rates Among Methadone Maintenance Treatment Patients in Two Clinics

Peles

Schreiber

Linzy³

et al. 2015

Journal of Substance Abuse Treatment

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Section: Discussionmentioning

confidence: 98%

Differences in Methylphenidate Abuse Rates Among Methadone Maintenance Treatment Patients in Two Clinics

Peles

Schreiber

Linzy³

et al. 2015

Journal of Substance Abuse Treatment

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“…Further, this meta-analysis did not include adult participants and the cardiovascular safety of methylphenidate should be considered in adult patients [18]. Schelleman et al (2012) could not find a causal association between methylphenidate and risk of serious cardiovascular events in adults [19]. The prevalence of cardiovascular adverse effects in adults is less commonly studied in the literature.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression

Liang

Lim

Tam

et al. 2018

IJERPH

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Objectives: This meta-analysis aims to study the effects of atomoxetine and methylphenidate on heart rate (HR), systolic blood pressure (SBP), and a number of adverse cardiac events on patients receiving treatment for attention-deficit hyperactive disorder (ADHD) in comparison to placebo and between atomoxetine and methylphenidate. Methods: We searched the following databases: PubMed, EMBASE, and ScienceDirect. Meta-analysis was performed on studies that examined the relationships between methylphenidate or atomoxetine and HR, SBP, as well as a number of adverse cardiac events. These studies were either placebo-controlled or comparison studies between methylphenidate and atomoxetine. Meta-regression identified patient- and treatment-related factors that may contribute to heterogeneity. Results: Twenty-two studies were included and the total number of participants was 46,107. Children/adolescents and adults treated with methylphenidate had more significant increases in post- vs. pre-treatment HR (p < 0.001) and SBP (p < 0.001) than those treated by placebo. Children and adolescents treated with atomoxetine had more significant increases post- vs. pre-treatment HR (p = 0.025) and SBP (p < 0.001) than those treated with methylphenidate. Meta-regression revealed mean age of participants, mean dose, and duration of atomoxetine and methylphenidate as significant moderators that explained heterogeneity. There were no differences in the number of adverse cardiac events between participants with methylphenidate treatment and placebo or atomoxetine. Conclusions: Children/adolescents and adults treated with methylphenidate resulted in significant increases in post- vs. pre-treatment HR and SBP as compared to placebo. Similarly, children and adolescents treated with atomoxetine had significant increases in post- vs. pre-treatment HR and SBP than those treated with methylphenidate. These findings have potential implications for continuous monitoring of HR and SBP throughout the course of treatment although the risk for adverse cardiac events were insignificant.

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“…Erişkin populasyonda 359 hastanın katılımıyla 24 haftalık çift kör plasebo kontrollü bir çalışmada sistolik ve diastolik kan basıncı değerlerinin metilfenidat kullanımında ciddi oranda yüksek saptandığı bildirilmiştir 5 . Erişkinlerde yapğılan başka bir çalışmada ise Torsade de pointese bağlı ani kardiyak ölüm, QT uzunluğunun eşlik ettiği polimorfik ventriküler taşikardi gibi yaşamı tehdit eden aritmilere neden olduğu belirtilmektedir 6 . 720 vakalık çocuk hastalarda yapılan bir çalışmada sadece 3 vakada kardiyak yan etki bildirilmiştir.…”

Section: Discussionunclassified

Rare Cardiac Effects of Methylphenidate: Mobitz Type 1 AV Block

Dervişoğlu¹,

Kösecik²

2016

Sakarya Med J

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ÖzMetilfenidat çocuklarda Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB)' nun tedavisinde sıklıkla kullanılan bir farmakolojik ajandır. Tedavi dozlarında oldukça güvenli bir ilaç olarak kabul edilir. Özellikle tedavinin ilk günlerinde klinik olarak anlamlı olmayan ve risk taşımayan, hafif düzeyde kan basıncı değişiklikleri görülebilirken daha yüksek dozlarda ciddi kardiyak aritmilerinde içinde bulunduğu önemli kardiyak yan etkilerin geliştiği bildirilmiştir. Yaşamsal önem teşkil eden yan etkiler oldukça nadir görülse bile, ilaç kullanımı sırasında hekimlerde ciddi endişelere sebeb olabilmektedir. Bizde bu yazıda DEHB nedeni ile metilfenidat kullanan, Mobitz tip 1 AV blok ile acile başvuran 8 yaşındaki erkek hastamızı literatüre katkı sağlamak amacıyla sunmak istedik. Abstract Methylphenidate is a commonly used pharmacological agents in the treatment of pediatric patients with Attention Deficit Hyperactivity Disorder (ADHD). It is considered to be a relatively safe drug in therapeutic doses. Especially in the early

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Methylphenidate and Risk of Serious Cardiovascular Events in Adults

Abstract: Although initiation of methylphenidate was associated with a 1.8-fold increase in risk of sudden death or ventricular arrhythmia, the lack of a dose-response relationship suggests that this association may not be a causal one.

Cited by 103 publications

References 25 publications

Differences in Methylphenidate Abuse Rates Among Methadone Maintenance Treatment Patients in Two Clinics

Differences in Methylphenidate Abuse Rates Among Methadone Maintenance Treatment Patients in Two Clinics

The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression

Rare Cardiac Effects of Methylphenidate: Mobitz Type 1 AV Block

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