Published online November 30, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1494-e1501 (doi:10.1542/peds.2007-0675)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Winterstein, A. G.
Right arrow Articles by Saidi, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Winterstein, A. G.
Right arrow Articles by Saidi, A.
Related Collections
Right arrow Neurology & Psychiatry

ARTICLE

Cardiac Safety of Central Nervous System Stimulants in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder

Almut G. Winterstein, PhDa,b, Tobias Gerhard, PhDa, Jonathan Shuster, PhDc, Michael Johnson, MDd,e, Julie M. Zito, PhDf,g and Arwa Saidi, MB, BCh, FAAPh

a Department of Healthcare Administration, College of Pharmacy
b Department of Epidemiology and Biostatistics, College of Public Health and Health Professions
c Department of Epidemiology, Biostatistics, and Health Policy, General Clinical Research Center
Departments of e Psychiatry
h Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
d Gainesville Mental Health Partners, Gainesville, Florida
f Department of Pharmaceutical Health Services Research, School of Pharmacy
g Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland

OBJECTIVES. Case reports have raised concerns about the risk of cardiac events associated with central nervous system stimulants for the treatment of attention-deficit/hyperactivity disorder.

PATIENTS AND METHODS. This was a retrospective cohort study that used 10 years (July 1994 to June 2004) of Florida Medicaid claims data cross-linked to Vital Statistics Death Registry data. The cohort was composed of all youth 3 to 20 years old who were newly diagnosed with attention-deficit/hyperactivity disorder. Each month of follow-up was classified according to stimulant claims (methylphenidate, amphetamines, and pemoline) as current use (active stimulant claim), former use (time after periods of current use), or nonuse (time preceding the first stimulant claim, including follow-up of youth who were never exposed to stimulants). The study's end points were (1) cardiac death, (2) first hospital admission for cardiac causes or (3) first emergency department visit for cardiac causes. Risks were compared with time-dependent Cox regression analysis adjusting for various cardiac risk factors.

RESULTS. During 124932 person-years of observation (n = 55383), 73 youth died, 5 because of cardiac causes. No cardiac death occurred during 42612 person-years of stimulant use. Hospital admissions for cardiac cause occurred for 27 children (8 during stimulant use, 11 during 35671 person-years of former use, and 8 during 46649 person-years of nonuse); and 1091 children visited the emergency department for cardiac causes (8.7 per 1000 person-years). Current stimulant use was associated with a 20% increase in the hazard for emergency department visits when compared with nonuse. No increased risk was found for periods of former use when compared with nonuse.

CONCLUSIONS. Incidence rates of cardiac events requiring hospitalization were small and similar to national background rates. Stimulants were associated with an increase in cardiac emergency department visits. More evidence is needed that addresses the long-term risk/benefit of the various treatment options and the effect of other cardiac risk factors and comedications.

Key Words: child and adolescent mental health • attention-deficit disorder • central nervous system stimulants • psychopharmacology • pharmacoepidemiology

Abbreviations: FDA—Food and Drug Administration • ADHD—attention-deficit/hyperactivity disorder • ICD-9—International Classification of Diseases, Ninth Revision • CM—clinical modification • ED—emergency department • HR—hazard ratio • CI—confidence interval

Accepted May 21, 2007.




This article has been cited by other articles:


Home page
 JWatch PediatricsHome page
The Safety of Stimulants in Children
Journal Watch Pediatrics and Adolescent Medicine, January 2, 2008; 2008(102): 2 - 2.
[Full Text]

Home page
 JWatch GeneralHome page
The Safety of Stimulants in Children
Journal Watch (General), December 27, 2007; 2007(1227): 2 - 2.
[Full Text]