The effect of pharmacotherapy for attention deficit hyperactivity disorder on risk of seizures in pediatric patients as assessed in an insurance claims database.
OBJECTIVE
To estimate the rate of new-onset seizure in ADHD patients in relation to ADHD pharmacotherapy.


METHODS
A retrospective cohort study of 34,727 patients, ages 6 to 17, with at least two insurance claims bearing ADHD diagnoses during 2003 in the UnitedHealthcare database. Incidence of seizure was calculated for observation time during treatment with atomoxetine and stimulants/bupropion.


RESULTS
Seizure incidence among ADHD patients was 4.5/1,000 person-years (p-y; 95% confidence interval 3.7 - 5.5). ADHD patients who received any ADHD medication had an incidence of 3.8/1,000 p-y (3.0 - 4.8) compared to 8.7 (5.8 - 12.4) for patients who did not receive any ADHD medication. The relative risk (RR) for current vs non-use of atomoxetine was 1.1 (0.6 - 2.1). For stimulants and bupropion, the RR for current vs non-use was 0.8 (0.6 - 1.3). Elevated seizure risks were found in association with central nervous system (CNS) disease (OR 3.9, 1.2 - 10.9), CNS medications (OR 2.2, 1.3 - 3.6), metabolic disease (OR 2.9, 1.1 - 6.8), and psychiatric disease risk factors (OR 1.7, 1.1 - 2.6).


CONCLUSIONS
In this study, there was no statistically significant association between use of atomoxetine or stimulants and seizure risk in children ages 6 to 17 years with ADHD and without prior seizure disorder.
McAfee
Andrew T
AT
1i3 Drug Safety, Waltham, Massachusetts, USA.
Holdridge
Karen C
KC
Johannes
Catherine B
CB
Hornbuckle
Kenneth
K
Walker
Alexander M
AM
D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects*; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology; D016642:Bupropion / Q000009:adverse effects*; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D002648:Child; D003257:Consumer Product Safety; D019992:Databases as Topic; D018765:Dopamine Uptake Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011437:Propylamines / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000139:chemically induced* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D018765:Dopamine Uptake Inhibitors; D011437:Propylamines; D016642:Bupropion; D000069445:Atomoxetine Hydrochloride