10.6. Analysis.
Comparison 10 Patient reports/series: number of participants with non‐serious adverse events, Outcome 6 Cardiovascular and respiratory system.
| Cardiovascular and respiratory system | |
|---|---|
| Study | |
| Vasculopathy | |
| Yu 2010 | These case reports raise the concern that adverse effects in the peripheral vascular system of children and adolescents may be associated with psychostimulant treatment Patient 1: Tachycardia at age 11 while taking Concerta, 54 mg/d. Vasculopathy at age 16. His hands and feet were a continuous blue colour on his hands and fingers, which increased in frequency in cold weather. He was diagnosed with "decreased circulation but not Raynaud's syndrome". Occured when the Concerta dose was increased from 54 mg/d to 90 mg/d in 3 months with the same Focalin (dexmethylphenidate) dose (10mg/d) Patient 2: Vasculopathy. First diagnosed with Raynaud's syndrome with finger pain and colour changes during a neurology consultation at age 10 years. At age 12 years had diffuse erythema of both earlobes, the fingers of both hands, and the toes of his left foot. Tics at age 10 years but not clear if these were present prior to treatment for ADHD Patient 4: Vasculopathy. After taking Focalin for a year, he developed persistent curling of the toes of both feet. In addition, he had reddish and purple colour changes in his hands and feet with cold exposure that lasted for 20 minutes. No associated pain and only rare paraesthesia. At age 10 years, toes 2, 3 and 4 of both feet were held in a flexed position ("curled toes"), and there was skin discolouration and excoriation |
| Cardiovascular problems | |
| Karaman 2010 | A case report of a 15‐year old boy with ADHD who developed pulmonary arterial hypertension (PAH) during OROS MPH treatment Fourth day of treatment: The patient began to experience occasional episodes of slightly shortness of breath. Continued over several months. Not associated with either exercise or anxiety At 18th month of treatment: Fainting. Normal weight. No sign of allergy, hypersensitivity, or sleep apnoea. Mean pulmonary arterial pressure of 40 mmHg at rest, otherwise no pathological findings from extensive testing (Examination: clear lungs, no murmurs, rubs, or gallops, and otherwise unremarkable. Laboratory tests, including C‐reactive protein, thyroid and liver function tests, electrolytes. Blood gases, antinuclear antibodies, D‐dimers, chest X‐ray, ventilation–perfusion scintigraphy, electrocardiography, respiratory function tests. Echography. Transthoracic echocardiogram: normal except for the mean pulmonary arterial pressure). No use of any other drug. No history of alcohol and substance use and no symptoms or signs of MPH misuse (intravenous injection). The personal and familial histories were also negative for pulmonary or cardiovascular diseases Discontinuation of OROS‐MPH, one month: free of symptoms After the fourth week of discontinuation: Mean pulmonary arterial pressure of 28 mmHg |
| Bleeding | |
| Grossman 1985 | A case report of a 7‐year‐old girl on methylphenidate treatment who developed idiopathic trombocytopenic purpura (ITP). Physical examination at the paediatric outpatient department found countless petechiae over the entire dermal surface. Numerous areas of purpura were noted, especially over her buttocks and extremities. Multiple areas of buccal mucosal and gingival bleeding with a large hematoma presented on the left lateral surface of her tongue. Clotted blood was seen in her nostrils and ear canals bilaterally. Bone marrow aspiration showed normal to increased megakaryocytes with normal red and white cell precursors. MPH was stopped and the patient was admitted. After one week of treatment for the condition, her petechia had begun to fade. She did not start on MPH again. There has been no recurrence of petechiae or bruising one year later. MPH use for seven months prior to presentation of ITP |
| Tachycardia | |
| Gracious 1999 | A case report of atrioventricular (AV) nodal re‐entrant tachycardia during stimulant treatment Key conclusions of the study authors: Stimulant medication may evoke onset of AV nodal tachyarrhythmias in patients who have the potential to develop them, possibly in combination with a selective serotonergic reuptake inhibitor Comments from the study authors: The cardiologist consulted believed this patient had a structural vulnerability of genetic etiology for the arrhythmia which was then precipitated by the stimulant |