Adderall and Ritalin: With Heart Risks Uncertain, What Should Patients Do?
Some Medical Advice About ADHD/ADD Drugs From Cardiologists And Psychiatrists
In mid-February 2006 came the news that an advisory panel of drug-safety experts recommended a "black-box" warning for Adderall, Ritalin, and the other ADHD/ADD drugs -- and that the FDA was not going to act on this advice, at least for the time being. This situation left many people understandably confused.
To address some of these concerns and questions, New York Times (NYT) reporter Benedict Carey interviewed some prominent cardiologists and psychiatrists (free registration required) for an article which was published on February 21, 2006. Mr. Carey's apparent aim was to provide some guidance to adult patients and the parents of pediatric patients in terms of how to proceed in view of the possible serious side effects associated with Adderall, Ritalin, and the other ADHD/ADD drugs. Here is a summary of his findings.
Primarily, it is people with high blood pressure, heart murmurs, or other cardiovascular problems who should be consulting with their doctors in order to determine whether Adderall, Ritalin, or some other ADHD/ADD drug is safe for them.
Along these line, concerning pediatric patients, Mr. Carey reports:
Some panel members expressed concerns about children with structural heart abnormalities who might be given stimulants. Perhaps the most common abnormality is hypertrophic obstructive cardiomyopathy, a thickening of the muscle that can cause a blockage — and death — when under stress.
Such problems are often not diagnosed before drug treatment begins, but a good pediatrician who is aware a child is being considered for stimulant treatment will often pick up a soft heart murmur that might reflect an abnormality, said Dr. Steven Nissen, chief of cardiology at the Cleveland Clinic and a panel member. "This seemingly small step could save a life," he said.
As for adult patients using Adderall or Ritalin, the emphasis is on one's blood pressure. From Mr. Carey's February 21 NYT article:
The biggest worry for adults is high blood pressure. Stimulants usually prompt slight increases in heart rate and raise blood pressure, and even these changes can increase the risk of heart problems in someone who is vulnerable, Dr. Nissen said.
"A smoker with high cholesterol and a family history of heart disease: that's a person I would be very concerned about taking stimulants," Dr. Nissen said.
From his interviews, Mr. Carey found that, generally, there are a few screening questions which would help a doctor determine whether or not Adderall or Ritalin is safe for a patient.
- Are there any congenital or structural heart defects?
- Are there unexplained bouts of dizziness or heart palpitations?
- Is there any family history of heart disease, in particular sudden deaths in close relatives who died young?
It seems advisable that doctors should be these few questions, at least, before prescribing Adderall, Ritalin, or another ADHD/ADD medication. If your doctor, or your child's doctor, is considering such treatments but has not asked, you should "volunteer" this part of your medical history for their decision-making.
(Posted by: Tom Lamb)
