From: Reuters
Published April 21, 2008 04:47 PM

Group urges heart test before kids get ADHD drugs

By Will Dunham

WASHINGTON (Reuters) - Children with attention deficit hyperactivity disorder should get their hearts checked before starting treatment with Ritalin or other stimulant drugs, experts recommended on Monday.

The American Heart Association called for these children to undergo an electrocardiogram, a test that detects and records the heart's electrical activity, before taking such drugs.

The group said it is not clear that these medications increase a child's risk of sudden cardiac death, but issued the new recommendations out of an abundance of caution.


"There's been concern that these drugs might be associated in a very small number of individuals' sudden cardiac arrest or sudden cardiac death," said Dr. Victoria Vetter of the University of Pennsylvania School of Medicine in Philadelphia, who led the panel that drafted the recommendations.

"There's no registry in the country to determine how many young people are dying from sudden cardiac arrest and what they might have causing that -- and similarly how many of those who die might be on these medications. So there's no causal information," Vetter added in a telephone interview.

Ritalin, Novartis AG's brand name for the generic drug methylphenidate, is a central nervous system stimulant prescribed to calm and focus children with ADHD, a condition marked by inattention, hyperactivity and impulsive behavior.

ADHD appears to be more common in children with heart conditions, the American Heart Association said in the recommendations, published in its journal Circulation.

The group said U.S. Food and Drug Association data showed that between 1999 and 2004, 19 children taking ADHD drugs died suddenly and 26 children had cardiovascular events such as strokes, cardiac arrests and heart palpitations.


Millions of U.S. children are taking ADHD drugs.

Research has indicated that stimulants like Ritalin can raise the heart rate and blood pressure. While these side effects are unimportant for most children with ADHD, they can be relevant for those with a heart condition, the American Heart Association said.

Some heart conditions can raise the risk for sudden cardiac death, which can happen when heart rhythm becomes erratic.

The association's recommendations call for a child to get an electrocardiogram before starting ADHD stimulant medications because the test may identify conditions like heart rhythm abnormalities that can trigger sudden cardiac death.

"It won't pick up every one. There will be some false positives. But it's a relatively inexpensive and simple test that doesn't hurt the children in any way and it will let us identify some of these children and know that they have heart conditions," Vetter said.

"We particularly don't want to scare people or to alarm them," Vetter said.

The group also urged doctors to evaluate the heart health of children already taking ADHD medications if they were not evaluated before they began treatment. If the electrocardiogram turns up trouble, that does not necessarily mean the child should not get ADHD medications, Vetter said.

"We would monitor those children more carefully -- start them on lower doses of drugs and see how they do," she said.

Two U.S. health agencies said last year they were launching a two-year assessment of potential heart risks from ADHD drugs.

(Editing by Maggie Fox and Philip Barbara)

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