Stimulants for ADHD Affect Heart Rate, EKG : Small increases seen in systolic (0.6-3.5 mm Hg) and diastolic (0.7-2.6 mm Hg) blood pressure.

Family history should include hypertrophic cardiomyopathy, long QT syndrome, Wolff-Parkinson-White syndrome, and Marfan syndrome.

Dr. Silva also recommends that all patients be screened with at least an electrocardiogram. An echocardiogram is more accurate and will show structural abnormalities, but it is not always readily available, he said.

“I think everyone should screen,” he noted.

Data on QT interval changes were inconsistent. All but one of the double-blind studies that the investigators reviewed reported no significant change in QT interval findings with stimulant treatment vs. placebo.

One study in adults reported a significant increase in the QTcB interval of 7 ms after 6 weeks of MPH treatment, compared with placebo (Biol. Psychiatry 2006;59:829-35).

Four open-label extension trials reported QT interval data. One of these found significant increases in QT intervals (using different formulas for QTcB and QTcF) after 15 weeks of MAS-XR treatment in children (Biol. Psychiatry. 2007;61:706-12).

In contrast, a study in adolescents reported a mean decrease in the QTcB of 4.6 ms after 6 months of MAS-XR treatment (CNS Spectr. 2005:10 [10 suppl. 15]:22-30). In addition, a study of adults treated with MAS-XR found significant increases in mean QTcB intervals of 7.2 ms and QTcF intervals of 2.9 ms (CNS Spectr. 2005;10 [12 Suppl. 20]:35-43).

Different formulas all correct for the QT interval differently, Dr. Silva said. In addition, it remains uncertain whether prolongation of the QTcB interval by these medications corresponds to an increase risk of sudden death.

“No deaths were reported in any of these studies with pretty large numbers,” Dr. Silva said.

Disclosures: Novartis Pharmaceuticals Corp. supported the study. Dr. Silva disclosed that he is a consultant and on the speakers bureau for Novartis.

'There aren't that many serious changes that occur, and there are some you see in the placebo group as well.'

Source DR. SILVA