ADHD Medications and Treatments
ADHD affects an estimated 3% to 5% of children and adults in the U.S. Dr. Richard Sogn shares information and advice about attention deficit hyperactivity disorder, including its causes, diagnosis, and promising ADHD treatments
Saturday, March 24, 2007
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:
- Chest discomfort.
- Severe shortness of breath, especially with exercise.
- Fainting spells or unexplained dizziness.
- High blood pressure.
- 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.
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Labels: ADHD
Monday, March 19, 2007
Scared From Treatment
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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Labels: ADHD, FDA, medications, risks
Thursday, March 01, 2007
FDA Approves New ADHD Drug Vyvanse
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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Technorati Tags: ADHD, ADD, FDA, health-and-wellness, Vyvanse, stimulant medications, d-amphetamine, Adderall XR, stimulent abuse
Labels: ADHD, FDA, stimulant medications, Vyvance
Monday, February 26, 2007
Risks of ADHD Drugs
Similar medication information handouts are already in use, or should be in use, by physicians and pharmacies as part of patient education and informed consent when medications are prescribed and dispensed. Updated handouts for all medications are readily available for purchase from a variety of reputable sources and should always be a part of patient education. I also think it is important to review the information in the handout with the patient or parent, as it gives them a chance to ask questions while in the doctor's office rather than trying to reach him/her by telephone sometime later. Medications should not be taken unless the patient understands why the medication was prescribed, the potential risks, side effects, benefits, and alternatives to taking the medication, and has had a chance to have their questions answered.
The draft for the Patient Medication Guides for each individual ADHD medication can be found on the FDA website.
The information contained within these handouts is not new. Although extremely rare, there have been reports of sudden death in patients taking ADHD medications who have underlying serious heart problems. Therefore a careful history and evaluation should be done before starting a medication. There have also been reports of stroke or heart attack in adults with risk factors for these events. There are rare psychiatric side effects (one in 1,000) reported (hearing voices, paranoia, mania), especially in individuals with a prior history of these events, or when a close relative has experienced similar problems.
The information contained within these handouts is not intended to alarm anyone, but to educate them, as should be done with any medication or "natural" product. ADHD affects approximately 3 – 7% of children and 4% of adults to a degree that it significantly interferes with functioning in many life activities, such as school, family and peer relationships, and occupational activities. The majority of these people are healthy, do not have a serious heart problem or defect or other serious medical problem, and could benefit from treatment.
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Technorati Tags: FDA, ADHD, ADD, medication warnings
Labels: ADD, ADHD, FDA, medications, risks
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Previous Posts
- ADHD Diagnosis: What Tests are Needed?
- Heart History and ADHD Medications
- Scared From Treatment
- FDA Approves New ADHD Drug Vyvanse
- Risks of ADHD Drugs
- Sleep Apnea or ADHD?
- Preschoolers with ADHD
- Natural Supplements and Vitamins and ADHD
- ADHD and Anxiety
- Provigil Dropped as ADHD Medication
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