Published online February 1, 2007
PEDIATRICS Vol. 119 No. 2 February 2007, pp. 409 (doi:10.1542/peds.2006-3029)

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LETTER TO THE EDITOR

Stimulants and Sudden Death: What Is the Real Risk?

Lydia Furman, MD
Department of Pediatrics
Rainbow Babies & Children's Hospital
Cleveland, OH 44106

To the Editor.—

The special article in Pediatrics entitled "Stimulants and Sudden Death: What Is a Physician to Do?"¹ concludes that the risk of sudden death in children and adolescents treated with stimulants is no different from the risk of sudden death in the general population. Although it is possible that this is correct, the available evidence does not substantiate the authors' conclusion, and readers need to be aware of the possibility of author bias.

Data from the Adverse Events Reporting System (AERS) of the Food and Drug Administration reveal 19 reported cases of sudden death in children/adolescents who were receiving stimulant medications (12 received amphetamines and 7 received methylphenidate). It is generally agreed that only 1% to 10% of actual serious adverse events are reported to AERS; thus, comparisons to population rates of sudden death among either all children/adolescents or those receiving stimulants are not possible.² Many children currently receive stimulant medications (2 million prescriptions are written per month).³ Given biological plausibility (ie, stimulants increase heart rate and blood pressure), it is likely that amphetamines and methylphenidate are not safe in children/adolescents with a variety of underlying undiagnosed cardiac conditions.⁴ The solution to this dilemma is not clear, but we cannot simply wish away the AERS data.

The authors of the article provided financial-disclosure data. In order of authorship, they receive 8, 3, 7, and 11 pharmaceutical sponsorships each (if I have counted correctly), via consulting, speaker's bureau, or sponsored research funds. These pharmaceutical companies produce attention-deficit/hyperactivity disorder medications including amphetamines and methylphenidate. Readers should include this information in their evaluation of the authors' conclusions.

REFERENCES

1. Wilens TE, Prince JB, Spencer TJ, Biederman J. Stimulants and sudden death: what is a physician to do? Pediatrics. 2006;118 :1215 –1219[Abstract/Free Full Text]
2. Musholder AD, Pamer CA. Postmarketing surveillance of suicidal adverse events with pediatric use of antidepressants. J Child Adolesc Psychopharmacol. 2006;16 :33 –36[CrossRef][Web of Science][Medline]
3. Rusk J. FDA's Pediatric Advisory Committee does not back black box for ADHD drugs. Available at: www.idinchildren.com/200604/frameset.asp?article=box.asp. Accessed December 1, 2006
4. Nissen SE. ADHD drugs and cardiovascular risk. N Engl J Med. 2006;354 :1445 –1448[Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This article has been cited by other articles:

				J. Conway, K. K. Wong, C. O'Connell, and A. E. Warren Cardiovascular Risk Screening Before Starting Stimulant Medications and Prescribing Practices of Canadian Physicians: Impact of the Health Canada Advisory Pediatrics, October 1, 2008; 122(4): e828 - e834. [Abstract] [Full Text] [PDF]

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Furman, L. Search for Related Content PubMed PubMed Citation Articles by Furman, L. Related Collections Office Practice Social Bookmarking                         What's this?