Pediatric Heart Expert Forum
ADHD meds
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ADHD meds

Hi, my 5.5 yr old son is just about to be DX with ADHD.  The treatment plan, I imagine will be medication.  I, of course will speak with his cardiologist prior to starting any medication.  My son has one VSD that is getting smaller, and one that has closed.  His heart is still slightly enlarged, but functioning normal.  All of the info I can find on the web says that ADHD meds should not be given to children with structural abnormalitites of the heart or serious heart conditions.  I am unsure if my son falls into this category?  Is a VSD considered a structural abnormality?    Thanks so much - I know you can not give me a definate answer as to the meds being safe for him or not, but if you could jsut give me an idea, also what do you consider to be the safest ADHD med?
Thank you from a concerned momma!
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Dear Concerned Momma,

There has been a lot of confusing and concerning information in the medical and lay literature about ADHD medications and their effects on the heart.  The concern has come lately from the use of stimulant medications and their supposed association with increased incidence of sudden cardiac death.  Let me be quite clear here:  there has been no good data to demonstrate that stimulant therapy increases the incidence of sudden cardiac death in the general population.  This is despite the article published by the American Heart Association initially recommending ECG screening of patients with ADHD who take stimulants.  As an aside, something that did not make the lay press was that there were major post-publication revisions to that recommendation that backed away from that statement.

With regard to your son’s ventricular septal defects (VSD’s), yes, they are considered structural abnormalities as well as congenital heart defects.  However, the concerns for stimulants that you have read on the web with regard to structural heart defects are vague.  The cardiac conditions that probably should cause people not to take these medications include cardiomyopathies, coronary artery abnormalities, arrhythmias, myocarditis (an infection of the heart), and severe valvular obstruction.  I don’t know your son’s complete anatomy, but if your cardiologist has cleared his coronary artery anatomy and he has no other problems other than the remaining VSD with some mild volume overload, he is probably okay.  Definitely discuss this with your cardiologist, though, to make sure.  He may have some mildly increased heart rate and blood pressure with these medications, but otherwise likely should not have any concerning findings.  I am not a developmental pediatrician, so do not know what the “safest” medication is for the treatment of ADHD.  I will say that these medications pretty much work similarly as stimulants, with the exception of Strattera, which works slightly differently.  That said, I do not know whether there is a different safety profile associated with it.

Finally, there are other medications besides stimulants that can be used for the treatment of ADHD, although these are often reserved for either complicated cases of ADHD or for those who have failed stimluants.  Your primary care provider can discuss which therapeutic agent he or she feels is best suited for the care of your child.
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Thank you so much for your response - this makes me feel better.  Yes, my son's arteries are fine, it just the one VSD left.  So, sounds like he will probably be quite safe with the medication, but I will be in touch with his own cardiologist as well.  Thanks again, from a concerned momma!
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