ADHD : Drug Risks and Precautions

by Food and Drug Administration (FDA)

(Page 4 of 4)

Public health officials are concerned that stimulants may be inappropriately prescribed for some adults with ADHD. "Stimulants do work, but we know that they increase blood pressure and pulse rate," says Andreason, which could lead to strokes and heart attacks. "These drugs are very strongly labeled for their risk to the cardiovascular system," he adds.

"Patients with hypertension shouldn't be getting stimulants," says Kate Gelperin, M.D., a medical officer in the FDA's Office of Drug Safety. "If your blood pressure is on the high side, these drugs are not for you." About one-third of U.S. adults have high blood pressure, according to a study published in the October 2004 issue of Hypertension, a journal of the American Heart Association.

Raymond Woosley, M.D., Ph.D., a clinical pharmacologist and vice president for health sciences at the University of Arizona, says, "There are a lot of people who don't know they have hypertension or heart disease. In many people, the first symptom of heart disease is sudden death." Woosley advises adults with ADHD who are prescribed stimulants to "make sure their doctor is fully informed of their total medical condition and get a complete medical workup to make sure they're not at risk."

Even those without hypertension who take stimulants may be at risk, says Gelperin. "It's not known whether adults who take stimulants over long periods of time may have an increased risk of sudden death, stroke, or heart attack," she says, "although we do know that people who take an overdose of stimulants experience these adverse effects."

Woosley also recommends that parents get their children checked by a qualified pediatrician before giving them stimulants for ADHD. Parents should not insist on a stimulant for their child based on the positive experience of a friend's child who is taking the stimulant or because a teacher suggests it, he says. A child should be examined by a doctor and diagnosed with ADHD before being placed on a stimulant. "A stimulant given to a child with ADHD can help to normalize them," he says, "but if given to someone who doesn't have the right diagnosis, it can make them worse." Once prescribed a stimulant, a child's blood pressure and heart rate should be monitored closely until the dosage is stabilized, and then yearly, says Woosley, since the way the body responds to medication is highly variable and may change over time.

Research has shown that people with ADHD who take stimulants in the form and dosage prescribed do not appear to be at as great a risk for addiction as previously feared. However, when stimulants are abused, the consequences can be extremely dangerous — even deadly. According to the National Institute on Drug Abuse, taking high doses of a stimulant can cause an irregular heartbeat, dangerously high body temperatures, and heart failure or lethal seizures.

"The FDA has received many reports over the years describing serious adverse effects, including death, associated with stimulant abuse or overdose," says Gelperin.

"Some people will like the effects of the stimulants — either performance enhancement or the euphoria — and will want to be diagnosed as having ADHD," says Higgins. "Where I get concerned is when college students or even professionals come to me and say, 'I have trouble with attention.' Everyone has trouble with attention at some point — particularly with boring tasks." We need to separate patients with some symptoms of ADHD from those who have a genuine disorder, he says.

Higgins is also troubled by parents who take their child's stimulant or someone else's and claim they feel better. "Stimulants are basically 'speed,'" he says, "and most people will be more productive with them. That doesn't mean they have a disorder."

Higgins says that, in his practice, he reserves stimulants for people who have severe impairment, for whom Strattera doesn't work, and who are not at risk for substance abuse.

How is ADHD Diagnosed?

According to the American Psychiatric Association, a person is diagnosed with ADHD if

• they often have either six inattention symptoms or six hyperactivity and impulsiveness symptoms
• symptoms continue for at least six months and are more frequent and severe than normal
• symptoms cause significant damage to social, academic, or work functioning
• some damage to functioning occurs in at least two settings, such as home, work, or school
• some damaging symptoms occurred before age 7
• the symptoms are not due to another disorder.

Inattention Symptoms

• does not pay close attention to details or makes careless mistakes
• has trouble keeping attention on activities
• does not seem to listen when spoken to directly
• does not follow through on instructions and fails to finish tasks
• has difficulty organizing tasks and activities
• avoids, dislikes, or is reluctant to do tasks requiring sustained mental effort
• loses things necessary to do tasks or activities
• is easily distracted
• is forgetful in daily activities.

Hyperactivity or impulsiveness symptoms

• fidgets with hands or feet or squirms in seat
• leaves seat at times when remaining seated is expected
• feels restless, or, in a child, inappropriately runs about or climbs excessively
• has difficulty taking part in leisure activities or playing quietly
• is "on the go" or acts as if "driven by a motor"
• talks excessively
• blurts out answers before questions have been completed
• has difficulty awaiting turn
• interrupts conversations or intrudes on others' activities.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.