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 "Our results suggest that the events are rare, however, parents and
clinicians should be aware of the potential for cardiac adverse
effects" in children taking methylphenidate, or Ritalin, said senior
author Nicole Pratt, of the University of South Australia in
Adelaide.
The findings of the new study show that more research is needed on
the potential side effects of the drug, she told Reuters health.
Methylphenidate, a stimulant, reduces impulsivity and hyperactivity
in children with ADHD, write Pratt and colleagues in the BMJ.
However, there have been concerns that the drug may be tied to heart
problems.
For the new study, the researchers used insurance data on 114,647
South Korean children up to age 17 with ADHD who received at least
one prescription for methylphenidate.
Between 2008 and 2011, 1,224 of the children developed
cardiovascular problems for the first time. Overall, 864 children
developed heart rhythm problems, 395 had high blood pressure, 57 had
heart attacks, 67 had strokes and 44 had heart failure.
Kids were about 61 percent more likely to have a heart rhythm
problem when they were taking methylphenidate than when they
weren't, the researchers found. Kids were most at risk for a heart
rhythm problem during the first three days of treatment, but the
increased risk disappeared once the child had been on the drug for
more than 56 days.
The risk for a heart rhythm problem was also highest among children
with congenital heart disease.
There was no overall increased risk of heart attacks while children
were being treated with methylphenidate, but there was a slightly
higher risk between eight and 56 days after the start of treatment.
No link was found between methylphenidate and high blood pressure,
stroke and heart failure.
Parents should not change their children's medications based on this
study's results, Pratt told Reuters Health in an email. Instead,
they should discuss their concerns with their child's doctor.
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"When the medicine is deemed necessary children should have blood
pressure and heart rate monitored to help mitigate any potential
risk," she said.
In an editorial, John Jackson notes that the researchers looked at
whether children experienced a heart problem near the time they
started taking methylphenidate, compared to when they weren't taking
the medication.
The study did not look at whether heart problems occurred more often
in those who started taking methylphenidate than in those who were
not prescribed the drug, wrote Jackson, of the Harvard T.H. Chan
School of Public Health in Boston.
The new study, "underscores the need to consider the severity of
ADHD symptoms and the option of non-stimulants for children with
high cardiovascular risk, to avoid uses that are entirely off label,
and to closely monitor patients for whom stimulants are critical for
their wellbeing and development," he wrote.
Pratt said it will be important to replicate these findings in other
populations.
"This information will help clinicians and parents weigh up the
risks against the benefits of treatment particularly in mild cases
of ADHD," she said.
SOURCE: http://bit.ly/1TNNZHd and http://bit.ly/1TNO2Tz BMJ, online
May 31, 2016.
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