Original Articles

Cardiovascular considerations of attention deficit hyperactivity disorder medications: a report of the European Network on Hyperactivity Disorders work group, European Attention Deficit Hyperactivity Disorder Guidelines Group on attention deficit hyperactivity disorder drug safety meeting

Robert M. Hamilton^a1 c1, Eric Rosenthal^a2, Martin Hulpke-Wette^a3, John G. I. Graham^a4 and Joseph Sergeant^a5 for the European Network of Hyperkinetic Disorders and the Association of European Paediatric Cardiology

^a1 Division of Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Ontario, Canada

^a2 Paediatric Cardiology, Evelina Children's Hospital, London, United Kingdom

^a3 Department of Pediatric Cardiology, Georg August, University Hospital, Göttingen, Germany

^a4 Child and Adolescent Psychiatry, University of Dundee, United Kingdom

^a5 Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands

Abstract

Regulatory decisions regarding attention deficit hyperactivity disorder drug licensing and labelling, along with recent statements from professional associations, raise questions of practice regarding the evaluation and treatment of patients with attention deficit hyperactivity disorder. To address these issues for the European community, the European Network for Hyperkinetic Disorders, through its European Attention Deficit Hyperactivity Disorder Guidelines Group, organised a meeting between attention deficit hyperactivity disorder specialists, paediatric cardiovascular specialists, and representatives of the major market authorisation holders for attention deficit hyperactivity disorder medications. This manuscript represents their consensus on cardiovascular aspects of attention deficit hyperactivity disorder medications. Although sudden death has been identified in multiple young individuals on attention deficit hyperactivity disorder medication causing regulatory concern, when analysed for exposure using currently available data, sudden death does not appear to exceed that of the general population. There is no current evidence to suggest an incremental benefit to electrocardiography assessment of the general attention deficit hyperactivity disorder patient. Congenital heart disease patients have an increased prevalence of attention deficit hyperactivity disorder, and can benefit from attention deficit hyperactivity disorder therapies, including medication. The attention deficit hyperactivity disorder specialist is the appropriate individual to evaluate benefit and risk and recommend therapy in all patients, although discussion with a heart specialist is reasonable for congenital heart disease patients. For attention deficit hyperactivity disorder patients with suspected heart disease or risk factor/s for sudden death, assessment by a heart specialist is recommended, as would also be the case for a non-attention deficit hyperactivity disorder patient. The identification of risk factors for sudden death should not automatically exclude the use of attention deficit hyperactivity disorder medication.

(Received August 09 2010)

(Accepted April 03 2011)

(Online publication July 19 2011)

Keywords

• Attention deficit hyperactivity disorder;
• stimulant;
• sudden death;
• heart disease;
• congenital;
• drug therapy;
• guidelines

Correspondence:

^c1 Correspondence to: Dr R. M. Hamilton, MD, FRCPC, Division of Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Tel: (416) 813-6142; Fax: (416) 813-7547; E-mail: robert.hamilton@sickkids.ca