title: Stimulant use following the publicity of cardiovascular safety and the introduction of patient medication guides.
abstract: To explore changes in stimulant utilization and pre-treatment electrocardiography (ECG) screening in response to cardiovascular (CV) safety concerns.
  
  
  
  Two source populations were established from Florida Medicaid Fee-for-service beneficiaries between 2001 and 2008: approximately 44 571 newly diagnosed attention deficit/hyperactivity disorder patients and 33 000 new stimulant users. Time-series design and Joinpoint analysis were used to describe monthly trend changes in stimulant initiation, persistence, dosing, and pre-treatment ECG screening.
  
  
  
  Initial and maintenance daily dose declined 6 mg (95% confidence interval [CI] -14 to -1.9) methylphenidate (MPH) equivalent dose from a steady 27 mg after Canada withdrew Adderall XR in February 2005; the trend rebounded to a daily dose of 23 mg, after the remarketing of Adderall XR and a debate in the US over issuing a boxed warning on stimulant CV safety in early 2006. Monthly initiation increased 3.9% (CI -1.0 to 9.1) after the boxed warning debate to 54 per 100 patients per month (CI 44 to 68), but declined 2.4% (CI -3.6 to -1.2) after requirement of medication guides in February 2007. Monthly ECG screening increased 3.2% (CI 2.3 to 4.2) after Adderall XR withdrawal and further increased 13% (CI 4 to 23) after the American Heart Association recommended pre-treatment ECG screening to 40 per 100 patients per month (CI 17 to 48).
  
  
  
  The first signal of stimulant CV safety concerns was followed by varying responses depending on the outcome measure used, suggesting that patients and physicians responded at different times after the publicity of safety concerns. Clinical consequences of the changes are uncertain. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Division of Child and Adolescent Psychiatry, University of Florida, Gainesville, FL, USA.|Department of Psychiatry, University of Florida, Gainesville, FL, USA.|Department of Pediatrics, University of Florida, Gainesville, FL, USA.|Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.|Department of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL, USA.
authors.forename: Regina
authors.initials: R
authors.lastname: Bussing
authors.affiliation: Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
authors.forename: Abraham G
authors.initials: AG
authors.lastname: Hartzema
authors.affiliation: Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.|Research Design and Analysis Program, University of Florida Clinical and Translational Science Institutes, Gainesville, FL, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Shuster
authors.affiliation: Department of Pharmaceutical Outcomes and Policy, Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, USA.|Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Segal
authors.affiliation: Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.|Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
authors.forename: Almut G
authors.initials: AG
authors.lastname: Winterstein
mesh_terms: D000662:Amphetamines / Q000008:administration & dosage / Q000009:adverse effects; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000517:prevention & control*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D004305:Dose-Response Relationship, Drug; D004348:Drug Labeling; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005431:Florida; D006801:Humans; D008297:Male; D008484:Medicaid; D008774:Methylphenidate / Q000008:administration & dosage* / Q000009:adverse effects; D017063:Outcome Assessment, Health Care; D013997:Time Factors; D014481:United States
chemical_list: D000662:Amphetamines; D000697:Central Nervous System Stimulants; C449521:SLI381; D008774:Methylphenidate
keywords: ADHD; drug utilization; pharmacoepidemiology