[Cardiovascular risk assessment for the use of ADHD drugs in children].
BACKGROUND
Drug therapy for ADHD (Attention Deficit Hyperactivity Disorder) has generally been regarded as safe. ECG screening of healthy children and adolescents before initiating this type of treatment appears to be usual in Norway, despite recommendations that ECGs should only be undertaken in individuals who are at risk. The purpose of this article is to clarify relevant guidelines for cardiovascular risk assessment for the use of ADHD drugs in children and adolescents, as well as to propose practical recommendations.


METHODS
The article is based on a literature search in PubMed completed on 1 October 2013, and on the author's own clinical experience and discretionary assessments.


RESULTS
The use of CNS stimulants and atomoxetine is associated with a slight rise in blood pressure and pulse rate, as well as small changes in QT interval. A small percentage of patients (5-10%) experience a clinically significant rise in blood pressure and pulse rate. Sudden death does not appear to occur more frequently in children and adolescents taking ADHD drugs in therapeutic doses than in children and adolescents who do not use such drugs. There is little knowledge available on the long-term effects of ADHD drugs on the cardiovascular system of otherwise healthy individuals, or on the risk related to the use of ADHD drugs in children and adolescents with cardiac disease. The drugs are thought to increase the risk of sudden cardiac death in some arrhythmia syndromes.


CONCLUSIONS
Our assessment is that caution should be exercised in the use of ADHD drugs in children with potentially dangerous cardiac arrhythmias. We recommend clinical examination and a thorough medical history review in order to identify individuals at risk before initiating drug therapy, and also suggest that it is not necessary for healthy children to be given an ECG examination before introducing ADHD drugs. In children with known cardiac disease, arrhythmia or risk factors for cardiac disease, ADHD treatment should be undertaken in consultation with a medical specialist with competence in pediatric cardiology.
Barneklinikken Haukeland universitetssykehus og Klinisk institutt 2 Universitetet i Bergen.
Ansgar
A
Berg
Klinisk institutt 2 Universitetet i Bergen.
Emelinn
E
Bråtane
Barneklinikken Oslo universitetssykehus, Rikshospitalet.
Hans Henrik
HH
Odland
Klinisk institutt 1 Universitetet i Bergen.
Christina
C
Brudvik
Klinikk psykisk helsevern for barn og unge.
Bjørg
B
Rosland
Barneklinikken Haukeland universitetssykehus.
Asle
A
Hirth
D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000465:Algorithms; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004562:Electrocardiography; D006331:Heart Diseases / Q000139:chemically induced / Q000175:diagnosis; D006801:Humans; D008487:Medical History Taking; D017410:Practice Guidelines as Topic; D011437:Propylamines / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors
D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride