Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e75-e80 (doi:10.1542/peds.2008-3138)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
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 arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Google Scholar
Right arrow Articles by Winterstein, A. G.
Right arrow Articles by Saidi, A.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Winterstein, A. G.
Right arrow Articles by Saidi, A.
Related Collections
Right arrow Therapeutics & Toxicology
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Cardiac Safety of Methylphenidate Versus Amphetamine Salts in the Treatment of ADHD

Almut Gertrud Winterstein, PhDa,b, Tobias Gerhard, PhDc, Jonathan Shuster, PhDd and Arwa Saidi, MBBChe

a Department of Pharmaceutical Outcomes and Policy, College of Pharmacy
b Department of Epidemiology and Biostatistics, College of Public Health and Health Professions
d Department of Epidemiology, Biostatistics and Health Policy, General Clinical Research Center
e Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
c Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, and Center for Education and Research on Mental Health Therapeutics, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey

OBJECTIVES: Safety concerns about central nervous system stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD) include adverse cardiac effects. This study aimed to compare the risk for cardiac events in users of methylphenidate and amphetamine salts.

METHODS: A retrospective cohort design using claims data from the Florida Medicaid fee-for-service program representing a total of 2131953 children and adolescents was used. The analysis included all beneficiaries who were between 3 and 20 years of age, enrolled between July 1994 and June 2004, had at least 1 physician diagnosis of ADHD and were newly started on methylphenidate or amphetamine salts. Each month of follow-up was classified according to stimulant use into current use or former use. We defined cardiac events as first emergency department (ED) visit for cardiac disease or symptoms. Risk between current users of methylphenidate versus amphetamine salts and former users of drugs in these categories was compared by using a time-dependent Cox proportional hazard model that adjusted for differences in gender; race; age; year of the index date; disability; congenital anomalies; history of circulatory disease; history of hospital admission; and use of antidepressants, antipsychotics, and bronchodilators.

RESULTS: A total of 456 youth visited the ED for cardiac reasons during 52783 years of follow-up. After adjustment for differences in covariates, the risk for cardiac ED visits was similar among current users of methylphenidate or amphetamines. Periods of former use had a similar risk between youth with an exposure history to methylphenidate or amphetamine.

CONCLUSION: Exposure to methylphenidate and amphetamines salts showed similar risk for cardiac ED visits. Additional population-based studies that address manifestation of serious heart disease, especially after long-term use, dosage comparisons, and interactions with preexisting cardiac risk factors are needed to inform psychiatric treatment decisions.

Key Words: central nervous system stimulants • methylphenidate • amphetamine • safety • cardiac events • psychopharmacology • attention-deficit/hyperactivity disorder • child and adolescent mental health • pharmacoepidemiology

Abbreviations: ADHD—attention-deficit/hyperactivity disorder • FDA—Food and Drug Administration • ED—emergency department • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification • SSI—Supplemental Security Income

Accepted Feb 27, 2009.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?