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Short-Term Cardiovascular Effects of Methylphenidate and Adderall

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ABSTRACT

Objective

The primary purpose of this study was to examine the cardiovascular effects of Adderall® (ADL) in a clinic-based group of youths with attention-deficit/hyperactivity disorder ranging in age from 4 to 17 years.

Method

One hundred thirty-seven patients were treated with either methylphenidate (MPH) or ADL. Youths prescribed MPH were given medication twice daily, and youths treated with ADL received medication once daily. Patients were evaluated under five conditions: baseline, placebo, 5 mg/dose, 10 mg/dose, or 15 mg/dose. Resting pulse, diastolic blood pressure, and systolic blood pressure were examined after 1 week at each treatment condition. Changes from baseline on these parameters were examined.

Results

The short-term cardiovascular effects of both ADL and MPH were modest. No patients experienced any clinically significant change in these cardiovascular measures during the course of this brief trial.

Conclusion

Since the short-term cardiovascular effects of ADL appear minimal, specific cardiovascular monitoring during short-term ADL treatment at doses of 15 mg/day or less does not appear to be indicated. In addition, under similar conditions, using similar methods, both medication treatments led to changes in blood pressure and pulse that were clinically insignificant.

Section snippets

Subjects

The patient population consisted of 195 youths aged 4 to 17 years referred by their pediatrician or family physician for diagnosis and/or treatment of ADHD to the Pediatric Assessment and Evaluation Services (PAES). The PAES was based in a large, urban, teaching hospital. Because of the clinical infrastructure of the treatment setting, youths referred to the PAES were enrolled in managed care plans and did not require emergent assessment or treatment. The diagnostic and pharmacological

RESULTS

Of the 137 youths who had complete data for this medication titration program, 82 received MPH and 55 received ADL as part of the pharmacological intervention. The age of the patients ranged from 4 to 17 years. These patients had a mean age of 10.5 years. No differences in gender, ethnicity, or ADHD subtype were found between the MPH and ADL group (Table 1). No patients had a history of hypertension, hypotension, or clinically significant cardiovascular disease.

DISCUSSION

This is the first study that has systematically assessed the cardiovascular effects of ADL and one of the largest studies that has specifically considered the cardiovascular effects of psychostimulants in young people. Using the same methods and under similar conditions, both ADL and MPH were found to have clinically insignificant effects on blood pressure and pulse. Regardless of medication type or dosage level, the cardiovascular effects of these psychostimulants seem generally modest at

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    Similarly, individuals exhibited increased pulse rate and SBP in the long-term study. Four studies compared the effects of two or more stimulant medications on cardiac indices (Conzelmann et al., 2019; Findling et al., 2001; Samuels et al., 2006; Vitiello et al., 2012) and were included in the narrative synthesis. In their study comparing the cardiovascular effects of MPH and Adderall (ADL), Findling et al. (2001) found statistically significant increases in pulse rate and DBP following each treatment.

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This work was supported in part by the Stanley Foundation, by the Schubert Foundation, by NIDA grant R01-DAO7957, and by grants MCJ-390592 and 390715 from the Maternal and Child Health Program (Title V, Social Security Act) Health Resources and Service Administration, Department of Health and Human Services. The authors thank all participating families. Special thanks are extended to Ms. Barbra DePasquale for scheduling patients and Ms. Heather Gilmore for manuscript preparation. Drs. Findling and Manos currently serve as consultants to and have their research funded in part by Shire Richwood Inc.

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