Loren Bonner
When taken for a long period of time and at a high dose, ADHD medication use was associated with an increased risk for some cardiovascular diseases, according to a research study published November 22, 2023, in JAMA Psychiatry.
Not only are more individuals being prescribed ADHD medication, but there’s a growing trend in the long-term use of the drugs.
The number of individuals receiving ADHD medications has increased worldwide, said a 2018 Lancet Psychiatry study, and the prevalence of ADHD medication use among children has risen over time in all countries and regions.
“These medications are typically started in childhood, but function- impairing symptoms often continue into adolescence and adulthood, and thus treatment is continued,” said Julie Dopheide, PharmD, a professor at the University of Southern California School of Pharmacy and Keck School of Medicine, who was not involved with the research.
Pharmacists are in a position to monitor prescriptions of ADHD medications to promote safe, therapeutic doses and discourage their use in individuals who have significant CV risk factors, said Dopheide.
Researchers of the new study examined data from several Swedish nationwide databases that included 300,000 individuals in Sweden ages 6 to 64 years. Using these data sets, their aim was to track the cumulative use of ADHD medication for up to 14 years and the risk of CVD. Previous studies haven’t looked past a 2-year mark in investigating the association between long-term ADHD medication use and the risk of CVD.
Specific outcomes, limitations
The research team found that longer cumulative duration of ADHD medication use was associated with an increased risk of CVD—particularly hypertension and arterial disease—compared with nonuse. They also found a correlation between ADHD medication dosage and an increased risk of CVD.
The dosage analysis showed that the risk of CVD associated with each year of ADHD medication use increased with a higher average defined daily dose. For example, among individuals with a mean defined daily dose of up to 1.5 to 2 times the standard dose, each 1-year increase in ADHD medication use was associated with a 4% increased risk of CVD.
While study findings indicated a 4% increased risk with each 1-year increase in ADHD medication use, the first 3 years of use were associated with the highest risk, after which the risk stabilized. The corresponding increased risk for the first 3 years was 8%. The research team observed similar results when examining children and adults separately.
Findings of the study also suggest that increasing cumulative durations of the specific ADHD medications methylphenidate and lisdexamfetamine, and at higher doses, were associated with incident CVD.
“Clinicians should be vigilant in monitoring signs and symptoms of cardiovascular disease, particularly among those receiving higher doses,” said lead author Le Zhang, PhD, from the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet in Stockholm, Sweden.
But, he noted, the study is observational and does not infer causal interpretations.
Dopheide said that the severity of ADHD was not looked at, nor were lifestyle factors that could have contributed to the risk.
“Stimulants are still effective for many people,” Dopheide said. “I just think the risks need to be understood.”
“Treatment decisions, as always, should be based on careful weighing of potential benefits and risks at an individual patient level, rather than simple one-size-fits-all recommendations,” said Zhang.
Takeaway
“I think ADHD meds are crucial treatments for people and they can help with self-esteem, but if we can keep the dose in check, or use behavioral interventions and other lifestyle modifications to decrease the dosage, that is best,” said Dopheide. “Multimodal treatment is best to find lowest stimulant dose.”
She said pharmacists can also talk to prescribers if they see a patient is exceeding a maximum dose.
Likewise, pharmacists can ask patients if they want to know more about the risks. ■