Heart History and ADHD Medications

Sudden cardiac death occurs in about 600 children per year in the United States. The most common cause is an inherited disorder called hypertrophic cardiomyopathy.

Medications used to treat ADHD should not be prescribed for children and adolescents with structural heart defects. A thorough health history should always be taken by the physician before prescribing any medication. Before prescribing medications for ADHD, make sure that your doctor or your child's doctor asks about a history of:

1. Chest discomfort.
2. Severe shortness of breath, especially with exercise.
3. Fainting spells or unexplained dizziness.
4. High blood pressure.
5. Unexplained deaths in family members below age 30, a family history of heart attacks prior to the age 50 in men or 60 in women, or a family history of congenital heart disorders.

If any of these possible risk factors are present, more extensive cardiac testing or a referral to a cardiologist would be justified.

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Technorati Tags: ADHD, ADD, ADHD medications, hypertrophic cardiomyopathy, sudden cardiac death, health-and-wellness

Scared From Treatment

Although the intent of the FDA's Black Box Warnings is to educate doctors, patients, and parents about the potential side effects of medications, I'm concerned that when combined with sensationalized and distorted media reporting, they frequently create unnecessary fear and the decision to stop treatment or to not seek treatment at all.

Tragically, current evidence suggests that the black box warning regarding the use of antidepressants in children and adolescents is related to a dramatic increase in the number of suicides. Ever since SSRI antidepressants have been prescribed to treat depression in children and adolescents, the annual rate of youth suicide has steadily declined. A media frenzy started in 2003 when committee meetings were held at the FDA to discuss data suggesting that a very small number of youth experienced an increase in suicidal thoughts shortly after an antidepressant had been started. The result of this frenzy was a 20% decline in the number prescriptions written for antidepressants for children and adolescents in 2003, and a very disturbing increase in suicides by 18.2% from 2003 - 2004.

There is now a media frenzy over the black box warnings regarding medications for the treatment of ADHD and the potential for cardiac side effects in someone with structural cardiac abnormalities or heart disease, which has frightened many parents and care providers. Yet untreated ADHD is related to increased rates of academic failure, low self-esteem, alcohol and drug use in adolescents and adults, motor vehicle accidents, relationship problems and occupational problems. Some children with ADHD are "traumatized" and demoralized by frequent negative interactions with teachers and peers and live in fear and humiliation, and "give up" on learning.

While it's very important that accurate information regarding medications and their potential side effects is well known to doctors, patients, and parents, there shouldn't be the effect of scaring people without risk factors away from needed treatment. Black box warnings need to do far more than identify risk factors of medications, as often the risk of not providing treatment far outweighs the risk of providing it. They should also include, "Warning: untreated depression is a major cause of suicide. Warning: untreated ADHD is a major cause of..."

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FDA Approves New ADHD Drug Vyvanse

The U.S. Food and Drug Administration approved Vyvanse (lisdexamfetamine dimesylate) for the treatment of ADHD. Vyvanse was designed to lower the potential for abuse. Stimulant medications are the first-line treatment for ADHD, but many clinicians are reluctant to prescribe stimulants because they are often misused in our society. However, children and adolescents with untreated ADHD are at an increased risk of developing a problem with substance use, and effective treatment of ADHD significantly decreases that risk.

The route of administration of a stimulant has a strong affect on abuse potential. Drugs that are rapidly absorbed and achieve higher blood levels can produce a euphoric effect. This effect is easier to obtain by crushing short acting tablets and snorting or injecting them. Longer acting tablets and capsules are not easily put into a form that can be snorted or injected, and thus have a less abuse potential.

Vyvanse is d-amphetamine (dextroamphetamine) that is linked or bound to a naturally occurring amino acid, l-lysine. This compound is inactive (is inert) until this bond is broken by enzymes (metabolized) in the GI tract (stomach and intestine), releasing the active drug, d-amphetamine.

Since there are no enzymes in the nasal passages that can break this bond, blood levels would be 96% lower if Vyvanse were snorted than if d-amphetamine were snorted, and 75% lower if it were injected. When given intravenously to adults with histories of stimulant abuse, Vyvanse produced less euphoric effects than d-amphetamine, and the effects were not significantly different than intravenous placebo.

Absorption of Vyvanse is delayed, compared to d-amphetamine, and without a quick onset, the intensity and "likability" (drug-seeking behavior) drops. When Vyvanse is taken orally, increasing doses produce increasing blood levels, but only up to a certain point (130 - 150 mg), beyond which higher doses will not produce higher blood levels, which might reduce abuse potential and toxicity from overdose.

Vynase is given once daily in the morning, and it is significantly effective until at least 6:00 PM. Its effectiveness, potential for side effects, and safety is comparable to Adderall XR. It does have the potential to reduce stimulant abuse or misuse, and may protect against toxicity from overdose.

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• WebMD Video: ADHD and Your Child
• Tips to Reduce the Side Effects of ADHD Medications

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