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attention-deficit hyperactivity disorder (ADHD) medication

medication used to treat inattention, including: - methylphenidate (Ritaline) - amphetamine (Adderall) - lisdexamfetamine (Vyvanse) - atomoxetine (Strattera) - pemoline (Cylert) Indications: - inattention - attention-deficit hyperactivity disorder (ADHD) - improves academic performance [7] - reduces risk of motor vehicle accidents [8] Contraindications: - avoid stimulants in patients with serious arrhythmias, symptomatic heart disease, or recent cardiovascular event Epidemiology: - ADHD medication use among reproductive-aged women increased > 300% 2003-2015 [10] Adverse effects: - no increase in cardiovascular risk [1,3] - potential risk of cardiac arrest & tachyarrhythmias [12] - stimulant use associated with hypertension, but not arrhythmia or ischemic heart disease [14] - stimulant use possibly associated with elevated long-term cardiovascular risk [15] - increase in suicide-related events associated with comorbidities rather than ADHD drug use per se [4] - linked to poorer sleep in children [5] - risk taking, poor control of aggression, & substance use [8] - long-term use into adulthood can stunt growth (up to 2 cm) [6] * Toxicity - treat with benzodiazepine Management: - methylphenidate first line for children - amphetamine first line for adults [11] - short-term treatment <= 12 weeks [11]

Interactions

drug adverse effects of ADHD medications

Related

attention-deficit hyperactivity disorder (ADHD)

Specific

amphetamine (Mydayis) atomoxetine (Strattera) methylphenidate (Ritalin, Concerta, Daytrana, Metadate CD, Centedrine) pemoline; phenylisohydantoin (Cylert, PIO)

General

psychotropic agent

References

  1. Habel LA et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults. JAMA 2011 Dec 28; 306:2673 PMID: 22161946 - Shaw P. ADHD medications and cardiovascular risk: Some heartening news. JAMA 2011 Dec 28; 306:2723 PMID: 22161945
  2. Prescriber's Letter 19(2): 2012 COMMENTARY: Pharmacotherapy of ADHD in Adults CHART: Comparison of Drugs for ADHD Detail-Document#: 280226 (subscription needed) http://www.prescribersletter.com
  3. Winterstein AG et al Cardiovascular safety of central nervous system stimulants in children and adolescents: population based cohort study BMJ 2012;345:e4627 PMID: 22809800 http://www.bmj.com/content/345/bmj.e4627
  4. Chen Q et al Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study. BMJ 2014;348:g3769 PMID: 24942388 http://www.bmj.com/content/348/bmj.g3769
  5. Orciari Herman A, Sadoughi S, Sofair A ADHD Meds Tied to Poorer Sleep in Children Physician's First Watch, Nov 23, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org (reference to pediatrics article)
  6. Davenport l Long-term ADHD Med Use: No Benefit, Negative Impact on Growth. Medscape - Mar 20, 2017. https://www.medscape.com/viewarticle/877438 - Swanson JM, Arnold LE, Molina BSG et al Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression. J Child Psychol Psychiatry. 2017 Jun;58(6):663-678. Epub 2017 Mar 10. PMID: 28295312
  7. Brauser D Medications Boost Academic Performance in ADHD Patients. Medscape - Jul 07, 2017. https://www.medscape.com/viewarticle/882597 - Lu Y, Sjolander A, Cederlof et al Association Between Medication Use and Performance on Higher Education Entrance Tests in Individuals With Attention-Deficit/ Hyperactivity Disorder. JAMA Psychiatry. 2017 Aug 1;74(8):815-822. PMID: 28658471
  8. Yasgur BS ADHD Medications Reduce Risk for Motor Vehicle Crashes. Medscape - May 12, 2017. https://www.medscape.com/viewarticle/879929 - Chang Z, Quinn PD, Hur K et al Association Between Medication Use for Attention-Deficit/ Hyperactivity Disorder and Risk of Motor Vehicle Crashes. JAMA Psychiatry. 2017 Jun 1;74(6):597-603. PMID: 28492937
  9. Melville NA Experimental ADHD Drugs Aimed at Aggression, Genetic Targets. Medscape - Jun 09, 2017. https://www.medscape.com/viewarticle/881351
  10. Anderson KN, Ailes EC, Danielson M, et al. Attention-Deficit/Hyperactivity Disorder Medication Prescription Claims Among Privately Insured Women Aged 15-44 Years - United States, 2003-2015. MMWR Morb Mortal Wkly Rep 2018;67:66-70 https://www.cdc.gov/mmwr/volumes/67/wr/mm6702a3.htm - Brooks M ADHD Prescriptions Skyrocket Among Young Women. Medscape - Jan 18, 2018. https://www.medscape.com/viewarticle/891501
  11. Cortese S, Adamo N, Del Giovane C et al Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. Aug 7, 2018 PMID: 30097390 Free Article https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30269-4/fulltext
  12. Zhang L, Yao H, Li L et al Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity Disorder. A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(11):e2243597 PMID: 36416824 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798903
  13. Torres-Acosta N, O'Keefe JH, O'Keefe CL Cardiovascular Effects of ADHD Therapies: JACC Review Topic of the Week. Lavie CJ. J Am Coll Cardiol. 2020 Aug 18;76(7):858-866. PMID: 32792083 Free article.
  14. Zhang L et al. Attention-deficit/hyperactivity disorder medications and long-term risk of cardiovascular diseases. JAMA Psychiatry 2024 Feb 1; 81:178. PMID: 37991787 PMCID: PMC10851097 Free PMC article https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2811812
  15. Holt A et al Long-Term Cardiovascular Risk Associated With Treatment of Attention-Deficit/ Hyperactivity Disorder in Adults. J Am Coll Cardiol. 2024 May 14;83(19):1870-1882. PMID: 38719367