http://www.cnn.com/2008/HEALTH/conditions/04/21/adhd.drugs.heart.ap/index.html?section=cnn_latest
Heart screening urged before kids get ADHD drugs
April 21, 2008
NEW YORK (AP) -- Children should be screened for heart problems with an
electrocardiogram before getting drugs such as Ritalin to treat hyperactivity
and attention-deficit disorder, the American Heart Association recommended
Monday.
Stimulant drugs can increase blood pressure
and heart rate. For most children, that isn't a problem. But in those with heart
conditions, it could make them more vulnerable to sudden cardiac arrest -- an
erratic heartbeat that causes the heart to stop pumping blood through the body
-- and other heart problems.
About 2.5 million American children and 1.5 million adults take medication for
attention-deficit hyperactivity disorder, or ADHD, according to government
estimates. Stimulant drugs, like Ritalin, Adderall and Concerta, help children
with ADHD to stay focused and control their behavior.
The medications already carry warnings of possible heart risks in those with
heart defects or other heart problems, which some critics said were driven more
by concerns of overuse of the drugs than their safety.
The heart group is now recommending a thorough exam, including a family history
and an EKG, before children are put on the drugs to make sure that they don't
have any undiagnosed heart issues.
"We don't want to keep children who have this from being treated. We want to do
it as safely as possible." said Dr. Victoria Vetter, a pediatric cardiologist at
the University of Pennsylvania School of Medicine and head of the committee
making the recommendation.
The label warnings were added after a review by the Food and Drug Administration
of its databases found reports of 19 sudden deaths in children treated with ADHD
drugs and 26 reports of other problems including strokes and fast heart rates
between 1999 and 2003. There were also reports of heart problems in adults; the
committee didn't look at adults.
An EKG can detect abnormal heart rhythms that
can lead to sudden cardiac arrest. Children who are already on ADHD
drugs should also be tested, Vetter said. If problems are found, the
child should be sent to a pediatric cardiologist. With careful monitoring,
Vetter said. children with heart problems can take the medicines if needed.
The cost of an EKG varies depending on who does it and the location. For
example, the amount that Aetna Inc. pays ranges from $24 to $50. Vetter said
Children's Hospital of Philadelphia, Pennsylvania, where she works, has been
doing EKG screening for three years and it has been covered by insurance.
She said a screening of about 1,100 children found that about 2 percent of them
had some kind of heart problem.
"We thought it was reasonable to include the electrocardiogram as a tool for the
pediatrician, the psychiatrist so that this would help identify additional
children who have heart disease," Vetter said.
But Dr. Steven Pliszka, a child psychiatrist at the University of Texas in San
Antonio, said he was baffled by the EKG recommendation. He said there's no
evidence that sudden death is a bigger problem for children taking stimulants
than for children who aren't taking the drugs.
Pliszka said an EKG might deter people from seeking treatment because it's an
added expense and hassle. Psychiatrists aren't likely to have an EKG machine,
and pediatricians might not either, making patients go elsewhere to get the
test, he said.
An ADHD advocacy group called CHADD said parents should monitor their child's
reaction to all medications. EKG screening "will bring an even further measure
of safety to what is already a safe clinical treatment approach," the group
said.
The American Academy of Child and Adolescent Psychiatry recently updated its
treatment guidelines for ADHD, and did not recommend routine EKGs, said Pliszka,
who was the lead author. He has received research support or served as a
consultant for makers of ADHD drugs.
"We definitely did not feel we needed to screen everyone," Pliszka said.
He noted that the heart association doesn't recommended EKG screening for young
athletes to prevent sudden death. The group has said it wasn't feasible or
cost-effective to screen all student athletes.
A spokeswoman for Novartis Pharmaceuticals Corp., which makes Ritalin, said the
company had not seen the latest heart association statement and could not
comment, but she pointed out that the label does suggest patients be evaluated
for heart problems.
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