Blood Pressure Changes with ADHD Medications

A study in the Feb. 05 issue of the Journal of Clinical Psychiatry (Wilens TE, Hammernes PG, Biederman J, Kwon A, Spencer TJ, Clark S, Scott M, Pdolski A, Dittlerline JW, Morris MC, Moore H) analyzed the effects of stimulants and nonstimulants on blood pressure and heart rate.

The subjects were adults with a mean age of 39 +/- 9 years. While there is little evidence of significant blood pressure changes in children treated with ADHD medications, less is known about adults who are at a higher risk because of underlying medical problems, and because the average age of diagnosis in adults is 35 - 40 years, a common time for problems with high blood pressure to first present.

Drug treatment for both stimulants and nonstimulants were associated with minor, but statistically significant changes in blood pressure and heart rate. Medications tested included bupropion (Wellbutrin), desipramine (Norpramin), amphetamine (Adderall, Dexedrine), and methylphenidate (Ritalin, Concerta, Metadate CD). Other studies of atomoxetine (Strattera) have shown similar changes. There was little difference between the different medications and their effects on blood pressure and heart rate. Some subjects receiving a placebo also had changes in blood pressure and heart rate, demonstrating the risk of developing high blood pressure in this age group.

This study emphasized the need for baseline and periodic monitoring of blood pressure and heart rate in adults receiving medications for ADHD. Blood pressure measurements over 140/90 might require a lowering or discontinuation of ADD medications, or the addition of a high blood pressure medication.

Related Topics: Hypertension: Medications Related to Hypertension, ADHD Medications Chart

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Daytrana: Medication Patch for ADHD Update

An FDA advisory panel has recommended approval of the transdermal methylphenidate patch (brand name Daytrana). It is recommended that the patch be applied in the morning and removed approximately nine hours later, or about two hours before bedtime.

There are many children who have difficulty swallowing pills, and liquid preparations of methylphenidate are short-acting and are effective for only about 3 - 4 hours, so Daytrana offers these children a longer-acting preparation. When the patch was left on for 12 hours, there was a significant incidence of insomnia, but when the patch in left on for nine hours, efficacy and side effects are fairly comparable to Concerta.

Improvements in symptoms of ADHD were found to occur within two hours of putting on the patch and persisted for approximately three hours after the patch was removed. The patch was primarily studied in children aged 6 - 12 years old, which is the only age group that the drug companies (Shire and Noven) are seeking FDA approval for. The patch is generally well-tolerated, and although redness can occur at the site of the patch (methylphenidate can irritate the skin), there is usually not itching or other signs of irritation that has occurred with other patches (e.g. the clonidine patch).

However, an unknown small number of children might develop a sensitization to methylphenidate, meaning that they could never take methylphenidate (patch, tablets, capsules, or liquid) again, and the advisory panel recommended that the PDR should include a warning about this possibility. It seems unusual that Shire Pharmaceuticals is involved with Daytrana, as they are the company that sell Adderall and Adderall XR, and for years have heavily advertised the advantages of Adderall products over methylphenidate products. Their new stance seems to be what most clinicians have said all along, that everyone is different and a particular individual may respond better to one medication than another. Generally, the FDA accepts the recommendations of their advisory panels, so hopefully, there will be another treatment option for ADHD available soon.

Related Topics: Stimulant Therapy for ADHD, Long-Lasting ADHD Patch May Be An Option

Technorati Tags: ADHD, medication, Daytrana, FDA

ADHD New Meds Roundup

It's time for my once-every-few-months New Medications Update. Here it is:

Sparlon (modafinil, Provigil) is still awaiting FDA approval for treatment of ADHD. It's currently authorized for treatment of daytime sedation related to narcolepsy. Approximately 50% of those with ADHD have shown moderate to good improvement. It will be a once-a-day preparation. As with other stimulants, decreased appetite and insomnia are the most common side effects, and there is sometimes a minor effect on blood pressure and heart rate. Sparlon has a low potential for abuse.

A new, long-acting preparation of Adderall will hopefully be released soon. On the plus side is that it can be dissolved in water, making it easier for children who have difficulty swallowing tablets and capsules. Since the drug has to be broken down and released by hydrolysis in the GI tract, and since little is released in the mucous membranes if it is snorted, or intravenously if it is injected, it has little abuse potential even though it's an amphetamine. The duration of action is approximately 12 hours, making it a once-a-day preparation.

Recent studies on Strattera (atomoxetine): A study by Hah and Chang published in the J. of Child and Adolescent Psychopharmacology, Vol. 15, No. 6, Nov. 6, 2005 reported on the use of atomoxetine for AD/HD in children and adolescents being treated for bipolar disorder with a mood stabilizer. Significant improvement in ADHD symptoms occurred in six of the seven patients studied, and addition of atomoxetine did not trigger hypomania or mania. Their conclusion was that Strattera might be safely and effectively added to a mood stabilizer in children and adolescents struggling with both Bipolar Disorder and ADHD. This is important because many children with Bipolar Disorder also struggle with ADHD.

Another study (J. Atten Disord. Oct. 2004;8(2):45-52 looked at the safety and efficacy of using atomoxetine in children and adolescents with ADHD and comorbid Oppositional Defiant Disorder. The conclusions of this study indicated that while Strattera was effective in treating ADHD in this group, and was well tolerated, it did not significantly improve symptoms of Oppositional Defiant Disorder.

Another study (Neurology. 2005 Dec 27;65(12):1941-9) looked at whether tics increased when atomoxetine was used to treat ADHD in children and adolescents with comorbid tic disorders. As expected, there was a significant reduction in symptoms of ADHD. Strattera did not increase tic symptoms in the 76 subjects studied (aged 7 - 17 y/o), and there was some evidence of a reduction of tic severity by the end of the 18 week study.

In March of 2004, the FDA advised close monitory of children and adolescents being started on one of the newer antidepressants for the potential of increased suicidal thinking and behavior. However, a new study by Dr. Gregory E. Simon and colleagues from the Group Health Cooperative in Seattle after doing a 10-year population based study of data on 65,000 patients, found that the highest risk for suicide is in the month prior to starting treatment. In the month following the start of treatment, the risk of suicide fell by half, and continued to fall over the next six months. The risk of a serious suicide attempt in the first month of treatment was much lower for the group treated with the newer antidepressants on the FDA's warning list, than for those treated with other medications. While anyone being started on any medication should be closely monitored for potential adverse side effects, many are worried that the dramatic increase in warnings about potential rare events might discourage effective treatment by many who need it. In this example, it appears that the risk of not being treated outweighs the risk of treatment.

Related Topics: Choosing the Right ADHD Medication for your Child, New Drugs Help Child, Adult ADHD

Technorati Tags: adhd, adderall, strattera, provigil

Adderall abuse in college students

Psychostimulants, including medications used to treat AD/HD, cocaine, and methamphetamine (speed), increase alertness and energy, elevate mood, improve task performance, and decrease fatigue, sleep, and appetite whether someone has AD/HD or not. When used in the typical doses used to treat AD/HD in someone who is healthy (e.g. without cardiac problems) stimulants are relatively safe and usually well-tolerated, and without long-term side effects.

If someone tolerates a couple of cups of coffee or a latte, they will probably tolerate stimulant medications. When used in high doses, especially when snorted or injected creating a rapid increase in brain blood levels, people experience euphoria but also anxiety, an increase in blood pressure and heart rate, insomnia, irritability, sometimes psychotic behavior, and often dependence.

Stimulants have been used for hundreds of years. Plantation owners in South America gave their workers leaves from the coca plant to chew on to increase stamina. During WW II, pilots were given amphetamines to fight fatigue on long missions. Truck drivers often use amphetamines to stay awake for long hours. In the past they were used as diet pills. Today psychostimulants are primarily used to treat narcolepsy and ADHD.

Chronic abuse of amphetamines can lead to physical dependence, and abrupt withdrawal of amphetamines in someone who is dependent is often associated with sedation and decreased energy, an increased appetite and weight gain, and sometimes severe depression and thoughts of suicide.

Medications generally don't create problems when they are taken for their intended use. For example, someone with an anxiety disorder such as panic disorder rarely misuses antianxiety medications such as Valium or Xanax. Someone who is "worried about everything" tends to be worried about medications and tends to take less than, rather than more than, the prescribed dose. People without an anxiety disorder might use Xanax to deal with stress of everyday life in the same way some people use alcohol and marijuana, which often leads to overuse and dependence. The same holds true for amphetamines and other stimulants.

People with ADHD rarely abuse their medication, and don't like feeling overstimulated from too high of a dose any more than they enjoy the jitteriness from too much caffeine. However, people who use amphetamines for the "high," to increase wakefulness and increase stamina, or to decrease appetite, often continue to use these drugs, often need higher and higher doses to achieve the same effects, and develop a drug problem.

Although there have been hundreds of studies involving thousands of subjects on ADHD and stimulants in children and adolescents, there are almost no studies on college students. However, it is not uncommon for students without AD/HD to misuse amphetamines to decrease their need for sleep, to decrease fatigue when studying for exams, and to increase mental alertness. Amphetamines are Class II controlled drugs, and their use by someone without a prescription is considered no different than purchasing cocaine or speed from the streets. A student who gives a few Adderall tablets to a friend, or sells a few tablets from his prescription is considered the same as if he were a drug dealer on the streats.

The question isn't whether a dose of Adderall will help someone without ADHD to have more energy, mental alertness, and stamina to study for exams, but whether the risk is worth the benefits. If it were me, I'd rather have a couple of latte's to stay awake and alert.

Related Topics: Ritalin: Prescriptions Don't Matter for Some
, Dealing with Substance Abuse

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ADHD Symptom: Forgetfulness

Life Tips: Learning to Remember

Forgetfulness, such as forgetting where you put your car keys, is a common symptom of ADHD in adults. Often, it's not related to a problem with memory but to having something else going on in your mind as you set down your keys.

If you said out loud, "I'm putting my keys on the kitchen table" instead of thinking about the good looking girl (or guy) you saw on the way home, you'd probably remember where you put them. A spouse might be leaving for work in the morning when their spouse askes them to pick up clothes from the cleaners on the way home that night. However, if they are thinking about their work day and don't really "hear" what their spouse says, "forgetting" to stop at the cleaners is not a problem with memory because it didn't get into the person's memory in the first place.

TIP: Put a hook by the door for your keys, or a basket where you toss your wallet, keys, and other daily items, then spend a few weeks focusing on placing them there every night when you come home. After a while it will become a habit, and you won't even have to "think" about it.

Related Topics: Women and ADHD, Adult ADHD

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