COMMENTARY

Recognizing and Managing Stimulant Complications

Adelaide S. Robb, MD

Disclosures

November 14, 2006

In This Article

Long-term Side Effects

Cardiovascular

No data from the long-term studies of MPH or amphetamines support the notion of stimulant-related development of heart disease or hypertension. At the US Food and Drug Administration (FDA) hearings in February and March 2006, the experts related the rates of sudden cardiac death in population studies and those of children receiving stimulants. One group that attended the hearings presented a table that summarized the important data, including sudden death in the general pediatric population (1.3-8.5 per 100,000 person-years), and for children receiving stimulants and atomoxetine (0.2-0.5 per 100,000 person-years), when the treatment effect size for the stimulants was 1.4-1.7.[29]

Growth

Studies looking at long-term growth for children on stimulants have reported a variety of answers to their effects on growth, but the concern for many parents and patients is that use of stimulants in childhood leads to shorter full adult height. The most recent of these investigations was a long-term study of patients in a large ADHD clinic who remained on 1 class of stimulants for at least 1 year and a subgroup of 63 children who received the same stimulant class for 3 years.[39] The investigators demonstrated that type of stimulant, sex, drug holidays, and time on medication did not change height z scores. Stimulants did affect weight over time, with patients becoming thinner and amphetamines causing more weight change than MPH.

A second study in 2006 looked at growth after 5 years of stimulant treatment.[40] These researchers noted that patients taking more than 1.5 mg/kg/day of MPH equivalent demonstrated less weight gain at 1 year, and those on more than 2.5 mg/kg/day had diminished gains in height at 4 years. This study used higher doses than those normally recommended for children. Even the adult studies used only 1.3 mg/kg/day equivalent of MPH, so the pediatric dose that caused height suppression was twice the dose recommended in adult studies.[41]

Neurologic

Studies of tics did not demonstrate that stimulant use leads to the long-term development of tics.[35]

Psychiatric

Although long-term studies have shown that many children with ADHD do have comorbid psychiatric disorders, none say that use of stimulants leads to the development of psychiatric illness.[12,42] Long-term use of stimulants has been shown to prevent the development of substance abuse.[8]

Sleep

Long-term rates of insomnia are as high as 29% in children with ADHD on stimulants, and 10% in those off stimulants, compared with 13.3% in those with other psychiatric diagnoses and 6.2% in normal controls.[43]

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