Adults with ADHD

jay_tarnowJay D. Tarnow, M.D.

Now that adults are increasingly being diagnosed with ADHD, questions are being raised about the long-term effects of stimulants on those adults.  Adult cardiovascular systems are clearly different than those of children.  In this case, adults are more vulnerable.

As people age, their blood pressure and heart rates have a tendency to rise.  Many people in our population develop hypertension in middle age as part of their aging process.  The wear and tear of our cardiovascular system over time makes adults more susceptible to increasing heart rates, heart failure, and heart attacks.  Diseases that affect the cardiovascular system such as Diabetes, Obesity, etc. can add to these problems.

Research with stimulant medications and even Strattera has focused on young healthy adults.  I have reviewed all of the available studies by the FDA and pharmaceutical companies.  The cut-off age is 50 years old.  Thus, data regarding the most vulnerable population is missing.  Most studies show a slight increase in vital signs of three to five beats per minute in heart rate, a 3-millimeter increase in systolic blood pressure, and 1-millimeter increase in diastolic blood pressure in the under 50 year old population.  What about the over 50?  This issue will need to be studied since more adults are being diagnosed as well as those ADHD children diagnosed 30 years ago who are still taking medication.

All stimulants and Strattera (Atomoxetine) should be used with caution in patients with known hypertension, tachycardia (rapid heart beats), and cardiovascular or cerebrovascular disease.  However, many adults with ADHD don’t go to doctors for physical exams on a regular basis.  Therefore, blood pressure and pulse must be evaluated before being placed on these medications and then followed regularly by the patient.  Being responsible for one’s health is an essential component of self-management.

I recommend that patients take their blood pressure and pulse at the pharmacy when they are refilling their prescription.  Report these findings to your doctor, this will catch a problem before if becomes serious.

All the medicines for ADHD have very clear warnings about use in patients with heart disease, heart failure, heart attacks, hypertension, as well as, seizure disorders.  Provigil and Wellbutrin (Bupropion) have been used off label in patients with ADHD who have cardiac problems.    However, in my experience both medications have increased blood pressure in some susceptible individuals.

There are no blood tests recommended to be used with stimulant medications on a routine basis.  I recommend that my patients have a yearly Liver Function test or when symptoms dictate.  A few patients on Strattera (Atomoxetine) have had increases in liver enzymes.  These have been reversible changes.  Signs of liver abnormalities are nausea, severe tiredness, diarrhea, muscle aches and pains, and jaundice (yellowing of skin and the white parts of the eyes).  Many people will describe the first signs of liver problems as a “flu”.  In these cases, ordering Liver Function Tests are appropriate.

The literature does not show that patients taking stimulants have a higher incidence of Alzheimer’s or Parkinson’s disease.  We are moving into a new era of treating adults with ADHD.  Thus physicians will need to be vigilant as we follow these patients over time.  Since I follow people for a long time I have a great deal of experience with this population that is not available elsewhere.

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