title: Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study.
abstract: OBJECTIVE
  To determine whether treatment with methylphenidate in children and young people with attention-deficit/hyperactivity disorder (ADHD) was associated with cardiovascular events.
  
  
  METHODS
  Self controlled case series analysis.
  
  
  METHODS
  Nationwide health insurance database, 1 January 2008 to 31 December 2011, in South Korea.
  
  
  METHODS
  1224 patients aged ≤17 who had experienced an incident cardiovascular event and had had at least one incident prescription for methylphenidate.
  
  
  METHODS
  A recorded diagnosis (either a primary or secondary cause) of any of the following cardiovascular adverse events: arrhythmias (ICD-10 (international classification of diseases, 10th revision) codes I44, I45, I47, I48, I49), hypertension (codes I10-I15), myocardial infarction (code I21), ischemic stroke (code I63), or heart failure (code I50). Incidence rate ratios were calculated with conditional Poisson regression and adjusted for time varying comorbidity and comedication.
  
  
  RESULTS
  Increased risk of arrhythmia was observed in all exposed time periods-that is, periods of treatment with methylphenidate-(incidence rate ratio 1.61, 95% confidence interval 1.48 to 1.74), and the risk was highest in the children who had congenital heart disease. No significant risk of myocardial infarction was observed for all exposed time periods (1.33, 0.90 to 1.98), though risk was higher in the early risk periods between eight and 56 days after the start of treatment with methylphenidate. No significant increased risk was observed for hypertension, ischemic stroke, or heart failure.
  
  
  CONCLUSIONS
  The relative risk of myocardial infarction and arrhythmias is increased in the early period after the start of methylphenidate treatment for ADHD in children and young people. Though the absolute risk is likely to be low, the risk-benefit balance of methylphenidate should be carefully considered, particularly in children with mild ADHD.
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: Ju-Young
authors.initials: JY
authors.lastname: Shin
authors.affiliation: School of Pharmacy and Medical Sciences, University of South Australia, Adelaide SA 5001, Australia.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
authors.affiliation: Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Byung-Joo
authors.initials: BJ
authors.lastname: Park
authors.affiliation: School of Pharmacy and Medical Sciences, University of South Australia, Adelaide SA 5001, Australia Nicole.Pratt@unisa.edu.au.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Pratt
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D015984:Causality; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013223:Statistics as Topic
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate