Child and Adolescent Psychiatric Clinics of North America
Understanding the Risk of Using Medications for Attention Deficit Hyperactivity Disorder with Respect to Physical Growth and Cardiovascular Function
Section snippets
Stimulants and physical growth
That long-term stimulant treatment of children can decrease growth velocity has been recognized for more than 30 years [9]. Several studies conducted in the 1970s and 1980s investigated the extent, persistence, and possible mechanisms of stimulant-induced growth suppression [10], [11], [12], [13], [14], [15], [16]. It was observed that the effect on weight typically emerges in the first few months of treatment, followed by attenuation, whereas the effect on height takes at least 1 year to
Atomoxetine and physical growth
Atomoxetine is a nonstimulant, selective noradrenergic reuptake inhibitor approved for the treatment of ADHD since 2003. Gastrointestinal adverse effects, such as appetite decrease, vomiting, gastric upset, and abdominal pain, frequently emerge early in treatment but seldom lead to drug discontinuation [45]. Acute treatment is on average accompanied by a slight decrease in weight of approximately 1 kg over a period of 2 to 3 months. Several open-label studies of atomoxetine administered for 2
Stimulants and cardiovascular function
Stimulants are sympathomimetic agents that increase noradrenergic and dopaminergic transmission. An effect on heart rate and blood pressure can be considered an intrinsic feature of their pharmacologic activity [48]. Hypertension and tachycardia are common in case of overdosing with these compounds [49]. Several placebo-controlled studies have documented a slight, but statistically significant, increase in blood pressure and heart rate in children and adults during short-term administration of
Atomoxetine and cardiovascular function
Atomoxetine is a selective norepinephrine reuptake inhibitor and an effect on the cardiovascular system can be expected given its pharmacologic properties. A review of five placebo-controlled clinical trials involving 612 children, adolescents, or adults treated with therapeutic doses of atomoxetine up to 10 weeks confirmed an increase 5 to 9 bpm in mean heart rate with suggestions of a dose-effect relationship [69]. Moreover, 3.6% of the children and adolescents on atomoxetine versus 0.5% of
α2-Agonists and cardiovascular function
Clonidine and guanfacine are marketed as antihypertensive drugs and do not have an official indication for the treatment of ADHD. They are, however, prescribed off-label alone or in combination with stimulants to children who have ADHD, especially in the presence of tic disorders or when other treatments prove insufficient [71]. Clonidine and guanfacine have prominent cardiovascular effects. They decrease blood pressure and can cause orthostatic hypotension, with dizziness, palpitations, and
Tricyclics and cardiovascular function
Although their use in children has decreased, tricyclic antidepressants still may be prescribed off-label for the treatment of ADHD in particular cases when stimulants or atomoxetine do not prove effective [71]. Tricyclics delay cardiac conduction and their use requires special attention to possible cardiotoxicity. Before starting treatment, children should receive a complete physical examination with ECG recording. Treatment should be considered only if the following limits are not exceeded on
Summary
In past few years, there has been a flurry of studies investigating growth in children treated with stimulants because of ADHD. Overall, the findings confirm that stimulants cause a slowing in growth velocity for weight and height, which can persist, although attenuated, for at least to 4 years, during continuous treatment. A slight decrease in weight and height velocity also is observed during treatment with atomoxetine. The clinical and practical significance of this effect on growth is
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2022, Comprehensive PharmacologyLong term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis
2021, Neuroscience and Biobehavioral ReviewsCitation Excerpt :Time of follow-up represents another important variable, when evaluating the possible impact of stimulants on growth: medication effects tend to attenuate over time both for weight and height. According to the results of previous reviews (Poulton, 2005; Vitiello, 2008), effects on height would manifest later in time with respect to weight (Faraone and Giefer, 2007; Spencer et al., 2006; Lisska and Rivkees, 2003), with a similar trend of generally remitting in time (Poulton and Cowell, 2003; Klein and Mannuzza, 1988; Safer and Allen, 1973), and time of follow up appears to be influenced by the condition of drug-naïvity at the beginning of the study. Drug naïve subjects have been shown to present a greater weight and BMI loss with MPH transdermal delivery system (Faraone and Giefer, 2007).
Prediction of sleep side effects following methylphenidate treatment in ADHD youth
2020, NeuroImage: ClinicalReducing the Clinical and Socioeconomic Burden of Narcolepsy by Earlier Diagnosis and Effective Treatment
2017, Sleep Medicine ClinicsCitation Excerpt :Sodium oxybate can cause nausea and abnormal neuropsychiatric effects and its use may be limited because of potential interactions with alcohol, sedative hypnotics, and other central nervous system depressants.66 As mentioned earlier, methylphenidate and amphetamines are associated with a potential for tolerance, abuse, and side effects that include growth suppression in children and cardiovascular disease in adults.41,42 In addition, nondrug therapies such as scheduled naps, diet modifications, and exercise play an important role in helping patients with narcolepsy manage their condition, but they do not eliminate the symptoms.51
The opinions and assertions contained in this report are the private views of the author and are not to be construed as official or as reflecting the views of the Department of Health and Human Services, the National Institutes of Health, or the National Institute of Mental Health.