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ADHD Drugs: Heart Screen Recommended

American Heart Association Calls for Electrocardiograms Before Kids Take ADHD Drugs
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WebMD Health News

April 21, 2008 -- Children and teens taking stimulants to treat attention deficit hyperactivity disorder (ADHD) should be screened for hidden heart problems, the American Heart Association now says.

In an updated consensus statement released today, the organization recommends that in addition to a careful medical history and physical examination, an electrocardiogram (ECG) be performed prior to starting any child or teenager on stimulant medications. This represents a departure from the previous scientific statement published about this topic in 1999.

More than 2.5 million children and teens in the U.S. take stimulants to control their ADHD. With careful monitoring the drugs have been shown to be safe even in those with known heart issues, cardiologist Victoria L. Vetter, MD, of the Children's Hospital of Philadelphia tells WebMD.

Vetter led the American Heart Association (AHA) panel that wrote the consensus statement.

"We aren't trying to scare doctors away from using these drugs, which are so important for the treatment of ADHD," Vetter says. "Most kids can be treated, but very careful monitoring is important."

(Did your child's doctor order these tests before prescribing? If not, will you have them done now? Talk with other parents on WebMD's Children with ADD/ADHD message board.)

ADHD Drugs Raise Heart Rate, Blood Pressure

Stimulants like the ADHD drugs Ritalin, Adderall, Dexedrine, and Concerta are known to increase heart rates and blood pressure, but the risk is not considered significant in otherwise healthy children who take the drugs for attention disorders.

The FDA requires that the labeling on stimulants used in the treatment of ADHD warn of a risk of sudden death in patients with heart problems. But the incidence of cardiac events among children and teens taking the drugs is not known because no registry exists to record these events, Vetter says.

In February 2005, Canada's drug regulatory agency briefly suspended the sale of the ADHD drug Adderall based on U.S. reports of sudden deaths in children.

In March 2006, an FDA panel reported that between 1992 and early 2005, 11 sudden deaths in children had been attributed to medications such as Ritalin and Concerta and 13 deaths were linked to amphetamines, such as Adderall or Dexedrine. Three sudden deaths were reported in children taking the ADHD drug Strattera, although Strattera is not a stimulant.

Studies suggest that ADHD is more common in children with heart problems than in the general pediatric population. And the obesity epidemic has led to an epidemic of high blood pressure among children and teens, Vetter says.

Since February 2007, the FDA has required that medications used to treat ADHD be accompanied by information warning about the use of these drugs in patients with heart problems. This has created a variety of dilemmas, including how to determine if a child has heart disease.

Vetter says her own preliminary research suggests that as many as 2% of children in the U.S. have undiagnosed heart problems that could be identified by ECG screening.

"This is definitely an issue that needed to be addressed," she says. The goal of the updated recommendations is to "allow treatment of this very significant problem of ADHD while attempting to lower the risk of these [medications]."

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