Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common of the pediatric neuropsychiatric disorders. Methylphenidate is an important element of therapeutic strategies for ADHD. Clinicians are interested in the safety of methylphenidate. Because this drug raises heart rate and blood pressure, concerns have been raised about its cardiovascular safety. Concerns were based on case reports of sudden cardiac death in methylphenidate users, plausible pharmacological pathways involving well-established stimulant effects on heart rate and blood pressure. Until recently, data were limited to a number of observational studies too small to examine serious cardiac events. In the past two years, large retrospective, population-based cohort studies were performed. These studies did not show any evidence that methylphenidate was associated with an increase in risk of myocardial infarction, sudden cardiac death, or stroke. Treatment of children with methylphenidate is not significantly associated with an increase in the short term or mid-term risk of severe cardiac events. For many, available data now will be seen as reassuring. But gaps persist in the methodical and comprehensive assessments of the safety of methylphenidate. Analyses cannot be generalized to children with long-term use of stimulants. Furthermore, long-term effects of slight increases in heart rate or blood pressure are unknown. Stimulant administration continues to have a detectable adrenergic effect even after years of treatment. In the MTA study, greater cumulative stimulant exposure was associated with a higher heart rate at years 3 and 8. Although less severe, such adverse cardiac events are nonetheless alarming to patients. This adrenergic effect may have clinical implications, especially for individual patients with underlying heart abnormalities and it deserves further investigation. More research is necessary to optimize a safe use of methylphenidate regarding its cardiovascular effects. In light of the controversies surrounding the increase in the number of children being diagnosed with ADHD, the broad use of methylphenidate in these patients, and cardiovascular concerns about it, this article addresses topics of clinical significance. For ease of use by practitioners, the article summarizes the guidelines stated by the European Medicines Agency over the appropriate pretreatment evaluation and cardiovascular assessment. It advocates a thorough history and physical examination before initiating methylphenidate to treat patients with ADHD, with an emphasis on the identification of risk factors for sudden death. A cardiac sub-specialist consultation is mandatory in case of history or physical examination findings. In other cases, an electrocardiographic screening is recommended in order to check out previously unrecognized heart disease.

译文

注意缺陷多动障碍(ADHD)是最常见的小儿神经精神疾病之一。哌醋甲酯是多动症治疗策略的重要组成部分。临床医生对哌醋甲酯的安全性很感兴趣。因为这种药物会提高心率和血压,所以人们对其心血管安全性也提出了担忧。关注的依据是哌醋甲酯使用者心源性猝死的病例报告,合理的药理学途径涉及对心律和血压的良好刺激作用。直到最近,数据还局限于一些观察研究,这些研究太小而无法检查严重的心脏事件。在过去的两年中,进行了大规模的基于人群的回顾性队列研究。这些研究没有显示任何证据表明哌醋甲酯会增加心肌梗塞,心源性猝死或中风的风险。用哌醋甲酯治疗儿童与严重心脏事件的短期或中期风险增加没有显着相关性。对于许多人而言,现在可用的数据将被视为令人放心的。但是,在对哌醋甲酯安全性进行系统和全面的评估时,仍然存在差距。不能将分析推广到长期使用兴奋剂的儿童。此外,心率或血压轻微升高的长期影响尚不清楚。即使经过多年的治疗,刺激性给药仍具有可检测到的肾上腺素作用。在MTA研究中,在第3和第8年,更大的累积兴奋剂暴露与更高的心率相关。尽管不那么严重,但此类不良心脏事件仍然令患者感到震惊。这种肾上腺素作用可能具有临床意义,特别是对于患有潜在心脏异常的个别患者,值得进一步研究。关于哌醋甲酯对心血管的影响,有必要进行更多的研究以优化安全地使用哌醋甲酯。鉴于围绕被诊断患有ADHD的儿童人数增加,这些患者广泛使用哌醋甲酯以及对此的心血管问题的争论,本文探讨了具有临床意义的主题。为了使从业者易于使用,本文总结了欧洲药品管理局在适当的预处理评估和心血管评估方面制定的指南。它倡导彻底的病史和身体检查,然后再开始使用哌醋甲酯治疗ADHD患者,并着重于确定猝死的危险因素。如果有病史或体格检查发现,必须进行心脏专科医生咨询。在其他情况下,建议进行心电图检查,以检查以前无法识别的心脏病。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录