Children with congenital heart disease and ADHD can benefit from stimulant medications

A new study finds that children with congenital heart disease and ADHD can take stimulant medications without fear of significant cardiovascular side effects.

In a study to be presented at a national meeting Oct. 4, researchers at Cincinnati Children's Hospital Medical Center have found no increased risk for death or changes in cardiac vital signs, such as blood pressure or heart rate, even for children with ADHD and severe heart conditions. They also found that when treated with stimulant medications, patients had significant improvements in ADHD symptoms as measured by standardized rating scales.

"Children with congenital heart disease are at high risk for ADHD, but fears about cardiovascular side effects, including sudden death, limit the use of stimulant medications," says Julia Anixt, MD, a developmental and behavioral pediatrician at Cincinnati Children's and senior author of the study. "This study indicates that stimulants are both effective and safe when prescribed with appropriate monitoring and in collaboration with the patient's cardiologist."

The study will be presented by Pon Trairatvorakul, MD, a fellow in the division of Developmental and Behavioral Pediatrics at Cincinnati Children's, at the annual meeting of the Society for Developmental and Behavioral Pediatrics in Las Vegas.

The researchers studied 44 children between the ages of 6 and 18 seen in the Cincinnati Children's Heart Institute Kindervelt Neurodevelopmental and Educational Clinic. They compared these patients to those with similar heart disease but who were not treated with stimulants. The researchers' next step is to study the effect of stimulant medications on electrocardiograms (EKGs), which measure electrical activity of the heart.

Since 2006, the U.S. Food and Drug Administration has required labeling of stimulant medications to include a warning that they generally should not be used in children and adolescents with serious structural cardiac abnormalities, cardiomyopathy or arrhythmias. However, stimulants are the most effective medication to treat ADHD symptoms, and patient families, cardiologists, and developmental pediatricians must together weigh the risks and benefits of medication treatment options for each individual patient, according to Dr. Anixt.