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European guidelines on managing adverse effects of medication for ADHD.

Graham J, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Döpfner M, Hamilton R, Hollis C, Holtmann M, Hulpke-Wette M, Lecendreux M, Rosenthal E, Rothenberger A, Santosh P, Sergeant J, Simonoff E, Sonuga-Barke E, Wong IC, Zuddas A, Steinhausen HC, Taylor E, European Guidelines Gro - Eur Child Adolesc Psychiatry (2010)

Bottom Line: The safety of ADHD medications is not fully known.These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality.Some of the effects examined appeared to be minimal in impact or difficult to distinguish from risk to untreated populations.

View Article: PubMed Central - PubMed

Affiliation: Child and Adolescent Psychiatry, The Centre for Child Health, Dundee, UK. JGraham3@nhs.net

ABSTRACT
The safety of ADHD medications is not fully known. Concerns have arisen about both a lack of contemporary-standard information about medications first licensed several decades ago, and signals of possible harm arising from more recently developed medications. These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality. A guidelines group of the European Network for Hyperkinetic Disorders (EUNETHYDIS) has therefore reviewed the literature, recruited renowned clinical subspecialists and consulted as a group to examine these concerns. Some of the effects examined appeared to be minimal in impact or difficult to distinguish from risk to untreated populations. However, several areas require further study to allow a more precise understanding of these risks.

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Related in: MedlinePlus

Recommendation for blood pressure (BP) monitoring and management in ADHD patients
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Fig1: Recommendation for blood pressure (BP) monitoring and management in ADHD patients

Mentions: Pre-treatment checking and monitoring of pulse and blood pressure are recommended with any ADHD medication in all patients with ADHD, with frequency of monitoring thereafter usually arbitrarily recommended as either three [67] or six monthly [140], but clearly this requirement may vary in individual cases. Sustained elevated blood pressure before or on treatment with stimulants requires assessment and treatment. Blood pressure should be measured prior to treatment and at each visit and converted to a centile score using the appropriate chart. If the first recording is elevated then it should be repeated at least twice and if still elevated, and above the 95th centile, then referral to a paediatric hypertension specialist is required, for 24-h ambulatory blood pressure recordings to confirm the diagnosis and to initiate any investigations for end organ damage. In patients already treated for ADHD, alternatively, a dose reduction or drug holiday could be proposed before referring to the specialist, the latter principally to confirm the potential role of the drug in the hypertensive state. Further management will depend on the severity of the blood pressure elevation and in consultation with the ADHD specialist might include antihypertensive treatment in addition to the stimulants, or discontinuation of the medication. A flow chart for both the ADHD specialist and hypertension specialist is attached (Fig. 1).Fig. 1


European guidelines on managing adverse effects of medication for ADHD.

Graham J, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Döpfner M, Hamilton R, Hollis C, Holtmann M, Hulpke-Wette M, Lecendreux M, Rosenthal E, Rothenberger A, Santosh P, Sergeant J, Simonoff E, Sonuga-Barke E, Wong IC, Zuddas A, Steinhausen HC, Taylor E, European Guidelines Gro - Eur Child Adolesc Psychiatry (2010)

Recommendation for blood pressure (BP) monitoring and management in ADHD patients
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3012210&req=5

Fig1: Recommendation for blood pressure (BP) monitoring and management in ADHD patients
Mentions: Pre-treatment checking and monitoring of pulse and blood pressure are recommended with any ADHD medication in all patients with ADHD, with frequency of monitoring thereafter usually arbitrarily recommended as either three [67] or six monthly [140], but clearly this requirement may vary in individual cases. Sustained elevated blood pressure before or on treatment with stimulants requires assessment and treatment. Blood pressure should be measured prior to treatment and at each visit and converted to a centile score using the appropriate chart. If the first recording is elevated then it should be repeated at least twice and if still elevated, and above the 95th centile, then referral to a paediatric hypertension specialist is required, for 24-h ambulatory blood pressure recordings to confirm the diagnosis and to initiate any investigations for end organ damage. In patients already treated for ADHD, alternatively, a dose reduction or drug holiday could be proposed before referring to the specialist, the latter principally to confirm the potential role of the drug in the hypertensive state. Further management will depend on the severity of the blood pressure elevation and in consultation with the ADHD specialist might include antihypertensive treatment in addition to the stimulants, or discontinuation of the medication. A flow chart for both the ADHD specialist and hypertension specialist is attached (Fig. 1).Fig. 1

Bottom Line: The safety of ADHD medications is not fully known.These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality.Some of the effects examined appeared to be minimal in impact or difficult to distinguish from risk to untreated populations.

View Article: PubMed Central - PubMed

Affiliation: Child and Adolescent Psychiatry, The Centre for Child Health, Dundee, UK. JGraham3@nhs.net

ABSTRACT
The safety of ADHD medications is not fully known. Concerns have arisen about both a lack of contemporary-standard information about medications first licensed several decades ago, and signals of possible harm arising from more recently developed medications. These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality. A guidelines group of the European Network for Hyperkinetic Disorders (EUNETHYDIS) has therefore reviewed the literature, recruited renowned clinical subspecialists and consulted as a group to examine these concerns. Some of the effects examined appeared to be minimal in impact or difficult to distinguish from risk to untreated populations. However, several areas require further study to allow a more precise understanding of these risks.

Show MeSH
Related in: MedlinePlus