Printer Friendly FormatSuggested guidelines for use of Ritalin
and other psychotropic drugs in children
From Pure Facts, January, 1999
As a result of several deaths, the AHA has issued recommendations on the use of drugs for ADHD and mood disorders.At their annual meeting in November, the American Heart Association (AHA) issued guidelines concerning the use of drugs such as Ritalin and imipramine. The report, written by the AHA's Committee on Congenital Cardiac Defects, suggests doctors administer electrocardiograms to identify children at risk for sudden cardiac death. The electrocardiogram should later be repeated after the child is established on the drug.
Physicians are encouraged to take a careful history to determine if the child is at risk. Symptoms to look for are palpitations and fainting, and a history of heart disease among family members.
Another caution offered by the AHA is the potential problem of drug interactions. Feingold volunteers are aware that many children with ADHD are given two or more drugs. When a child is placed on Ritalin and becomes depressed, parents often report that Prozac or a similar drug is added. In some cases, the combination makes it difficult for the child to sleep, and a third drug is prescribed. Dr. Bennett Leventhal, a professor of child and adolescent psychiatry at the U of Chicago, expressed his hope that the AHA recommendations will help remove the barriers that prevent the use of these drugs in more children.
The following information has been added:
See the published report of the Committee here. Note that the table linked to the article contradicts it by stating that "No specific cardiovascular monitoring is indicated."
See some of the research on the connection between Ritalin and cardiovascular problems. Note the Findling 1996 study of 7 children and 4 adults in which one adult had a 20 mm Hg rise in diastolic blood pressure on only 22.5 mg Ritalin a day combined with antidepressant - this is a very significant rise in pressure, and he comprised about 10% of this small study; nevertheless, they concluded that the combination of Ritalin and antidepressants "might be safe."
In 2000, after 14-year-old Matthew Smith died, the Feingold Association became aware of the connection between stimulant medication and "small vessel" heart disease, and stimulants and blood pressure. We contacted the AHA about the Brown studies of 1984, 1988, and 1989, which had concluded that "Because of the unexpected increase in diastolic blood pressure, careful monitoring of black adolescents who are receiving methylphenidate is recommended." Although Matthew had been White, we specifically asked them if they provide guidelines to the effect that there is any risk of Ritalin causing "small vessel heart disease" in children, and that Black children may be even more at risk of blood pressure rise and should be monitored. They said that they had not read the studies (published more than 11 years earlier). We asked them to please read them. The result was that the link from their home page to their information about the safety of Ritalin was removed. Ritalin was removed from their search engine. They declined, however, to issue any warning about small vessel disease, and nowhere do they warn doctors to be more careful with their Black patients.