Retrospective analysis of adverse events associated with non-stimulant ADHD medications reported to the united states food and drug administration

Pang, Lindsy; Sareen, Romil

doi:10.1016/j.psychres.2021.113861

Cited by 7 publications

(6 citation statements)

References 46 publications

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Section: Results/literature Summarymentioning

confidence: 99%

“…3 Of note, suicidal tendency is among the top 20 reported adverse effects of nonstimulant medications. 91 Suicidal ideation and mania are serious potential adverse effects of viloxazine; less serious adverse effects include elevated blood pressure and heart rate, headache, and fatigue. 92 The Role of Exercise in the Treatment of ADHD Despite being the most commonly diagnosed pediatric psychiatric disorder, 93 the prevalence of ADHD may be disproportionately represented in athletes because of the attention-activating effects of physical activity.…”

Section: Pharmacotherapymentioning

confidence: 99%

“…5 Its adverse effects include gastrointestinal disturbance, weight gain, liver toxicity, and hypertensive crisis. 1,3,91 Clonidine and guanfacine, both a 2 agonists, are also nonstimulant options with common adverse effects of dizziness, sedation, bradycardia, hypotension, and QT prolongation. 1,3 TCAs are another off-label option, but the potential adverse effects (eg, weight gain, dry mouth, fatigue, cardiac dysrhythmia) often prevent their use in athletes.…”

Section: Pharmacotherapymentioning

confidence: 99%

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Athletes With Attention-Deficit/Hyperactivity Disorder: Position Statement of the American Medical Society for Sports Medicine

Pujalte

Narducci

Smith

et al. 2023

Clinical Journal of Sport Medicine

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Athletes of all ages may be affected by medical and mental health issues. Sports medicine physicians should be familiar with common conditions that may affect the well-being of athletes, such as attention-deficit/hyperactivity disorder (ADHD). ADHD behaviors have the potential to affect a person's ability to concentrate. It is likely that social and cognitive therapies combined with pharmacotherapy will be the most effective way to treat ADHD in athletes. Medications used for ADHD, especially stimulant types, are known to improve alertness, reaction time, anaerobic performance, and endurance, which would potentially improve athletic performance. Furthermore, stimulant medications may enable student athletes with ADHD to focus on academic studies for longer periods of time, beyond usual levels of fatigue, important for those who may be exhausted after practices and games. The purported performance enhancement effects and potential adverse effects of stimulant medications have prompted many sports governing bodies to ban prescription stimulants or establish strict rules for their use. Athletes taking physician-prescribed stimulants to treat ADHD need to provide the appropriate documentation for approval before competition or risk punitive measures. Physicians should strive to provide a high quality of care to athletes with ADHD through early diagnosis, appropriate and careful multidisciplinary treatment, and complete and timely documentation to facilitate continued sports participation.

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Section: Results/literature Summarymentioning

confidence: 99%

Section: Pharmacotherapymentioning

confidence: 99%

Section: Pharmacotherapymentioning

confidence: 99%

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Athletes With Attention-Deficit/Hyperactivity Disorder: Position Statement of the American Medical Society for Sports Medicine

Pujalte

Narducci

Smith

et al. 2023

Clinical Journal of Sport Medicine

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“…Due to the ability of the stimulant medication to reduce ADHD symptoms in the short term, medication is currently the most common treatment for ADHD in children, often being chosen as a first-line treatment (Carucci et al, 2021;Mechler et al, 2022;Quenneville et al, 2022). However, medication treatment may be accompanied by side effects such as headaches, stomach pain, and decreased appetite (Pang and Sareen, 2021). Because of the potential side effects associated with medication treatment, nonpharmacological treatments with relatively lower side effects have developed rapidly in recent years (Cortese et al, 2022), such as physical activity interventions (Kleeren et al, 2023), neurofeedback interventions (Garcia Pimenta et al, 2021), and cognitive interventions (Pauli-Pott et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Effect of physical activity on attention in school-age children with ADHD: a systematic review and meta-analysis of randomized controlled trials

Li,

Zang

et al. 2023

Front. Physiol.

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Background: Attention problems are one of the core symptoms of Attention-deficit/hyperactivity disorder (ADHD) in children. Previous studies have shown that physical activity intervention has a positive impact on executive function in children and adolescents with ADHD, but there is limited research on attention problems in school-aged children with ADHD. There are still uncertainties about the appropriate physical activity interventions to improve attention problems in this population. This study conducted a Meta-analysis of randomized controlled trials (RCTs) related to physical activity intervention for attention problems in school-aged children with ADHD, providing a certain reference for precise intervention in attention problems for this population.Methods: We systematically searched the following databases up to October 2022: PubMed, Embase, Web of Science, and Cochrane Library, to identify RCTs that investigated the effects of physical activity interventions on children with ADHD. Two investigators independently conducted literature screening, extraction, and quality assessment. We performed a meta-analysis using Stata 15.1.Results: In total, we included 10 studies in this meta-analysis. The results indicated that physical activity intervention had a moderate effect in improving attention problems in school-aged children with ADHD (SMD = −0.48, 95% CI: 0.85, −0.07, p < 0.05). Furthermore, subgroup analysis showed that the effect of physical activity intervention was moderated by intervention type, frequency, and period, rather than the physical activity environment or single intervention time.Conclusion: Our study suggests that cognitively engaging exercise is more effective in improving attention problems in school-aged children with ADHD. Specifically, when cognitive-engaging exercise is used as the type of physical activity and the intervention frequency is less than 3 times per week, with an intervention period of less than weeks, it is most beneficial for improving attention problems in school-aged children with ADHD. However, we should also consider individual differences in children with respect to their ADHD symptoms and accurately evaluate each child’s specific symptoms before intervention.Systematic Review Registration: identifier (CRD42022363255).

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“…Non-stimulants, such as atomoxetine, guanfacine, clonidine, and viloxazine [ 13 ] are considered second-line ADHD therapeutics. Non-stimulants are also commonly associated with adverse events such as fatigue, somnolence, agitation, and aggression and they tend to be less effective than stimulants [ 14 ]. Importantly, about one-quarter of patients do not benefit from treatment with neither stimulants nor non-stimulants [ 7 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Novel non-stimulants rescue hyperactive phenotype in an adgrl3.1 mutant zebrafish model of ADHD

Sveinsdóttir¹,

Christensen²,

Þorsteinsson³

et al. 2022

Neuropsychopharmacol.

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ADHD is a highly prevalent neurodevelopmental disorder. The first-line therapeutic for ADHD, methylphenidate, can cause serious side effects including weight loss, insomnia, and hypertension. Therefore, the development of non-stimulant-based therapeutics has been prioritized. However, many of these also cause other effects, most notably somnolence. Here, we have used a uniquely powerful genetic model and unbiased drug screen to identify novel ADHD non-stimulant therapeutics. We first found that adgrl3.1 null (adgrl3.1−/−) zebrafish larvae showed a robust hyperactive phenotype. Although the hyperactivity was rescued by three ADHD non-stimulant therapeutics, all interfered significantly with sleep. Second, we used wild-type zebrafish larvae to characterize a simple behavioral phenotype generated by atomoxetine and screened the 1200 compound Prestwick Chemical Library® for a matching behavioral profile resulting in 67 hits. These hits were re-assayed in the adgrl3.1−/−. Using the previously identified non-stimulants as a positive control, we identified four compounds that matched the effect of atomoxetine: aceclofenac, amlodipine, doxazosin, and moxonidine. We additionally demonstrated cognitive effects of moxonidine in mice using a T-maze spontaneous alternation task. Moxonidine, has high affinity for imidazoline 1 receptors. We, therefore, assayed a pure imidazoline 1 agonist, LNP599, which generated an effect closely matching other non-stimulant ADHD therapeutics suggesting a role for this receptor system in ADHD. In summary, we introduce a genetic model of ADHD in zebrafish and identify five putative therapeutics. The findings offer a novel tool for understanding the neural circuits of ADHD, suggest a novel mechanism for its etiology, and identify novel therapeutics.

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Retrospective analysis of adverse events associated with non-stimulant ADHD medications reported to the united states food and drug administration

Cited by 7 publications

References 46 publications

Athletes With Attention-Deficit/Hyperactivity Disorder: Position Statement of the American Medical Society for Sports Medicine

Athletes With Attention-Deficit/Hyperactivity Disorder: Position Statement of the American Medical Society for Sports Medicine

Effect of physical activity on attention in school-age children with ADHD: a systematic review and meta-analysis of randomized controlled trials

Novel non-stimulants rescue hyperactive phenotype in an adgrl3.1 mutant zebrafish model of ADHD

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