Pediatricians on ADHD Drug Heart Risk
The American Academy of Pediatrics has issued a new policy contradicting the American Heart Association’s: stance that children prescribed stimulant medication Schedule II drugs should get a heart screening or EKG prior to taking the drugs. The American Heart Association (AHA) cited the fact that approximately 2.5 million children taking these drugs are at risk of elevated blood pressure and increased heart rate.
The FDA recently insisted that a warning be placed on the medication’s labels indicating risks for sudden deaths in patients with heart problems. Approximately 20-30 sudden deaths have been reported related to stimulant medication in the US and Canada.
The longest study on families and their use of medication, the Multi-modal Treatment of ADHD Children (MTA) study also indicated other side-effects including decreased height and weight.
The American Academy of Pediatricians (AAP) has taken the stance that children taking stimulant medication do not need and ECG or EKG (electrocardiogram) tests because the rate of death is very small in respect of the overall number of children taking the medication. The AAP contends that EKGs are expensive [around $100] and could delay access to effective ADHD treatments which “could have serious implications.” The AAP does advocate careful physical examination, and a review of family history of heart problems including sudden death. It does not, however, advocate routine EKGs.
According to the Associated Press, policy co-author Dr. James Perrin, a Massachusetts General Hospital pediatrician said the academy’s policy makes clear that there’s no scientific evidence to support “this fairly dramatic practice change.”
This is a rather disconcerting stance for several reasons. The first reason is that there are no long-term data demonstrating the safety or risks of stimulant medication especially in conjunction with cardiovascular risk. Secondly, according to the AHA, children with heart abnormalities have a higher incidence of ADHD. Third, stimulant medications are known to decrease both height and weight in children.
It’s also perplexing that the APA advocated cholesterol drug treatment for children as young as 8 years old. Given this history, then it is not out of character for the APA to minimize heart risk.
