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Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi

Year 2014, Volume: 2 Issue: 3, 99 - 103, 12.07.2016

Abstract

Son yıllarda çocuklarda ve gençlerde Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB) giderek artmaktadır. Metilfenidat (MPH), DEHB tedavisinde çocuk ve ergen psikiyatristler tarafından en çok tercih edilen ilaçtır. Ancak, hipertansiyon ve ritm bozuklukları gibi yan etki-ler görülebilmektedir. Bu çalışmada; MPH tedavisi sonrası elektrokardiyografik değişiklikleri araştırmayı amaçladık. DEHB tanısı konulup MPH kullanımı öncesi kardiyak değerlendirme amacıyla çocuk kardiyoloji polikliniğine yönlendirilen 41 hastanın anamnezleri, fizik muayene bulguları ve 12 derivasyonlu elektrokardiyografileri dosyalarından retrospektif olarak tarandı. Kontrol grubu ise üfürüm nedeniyle değerlendirilen ve ekokardiyografileri normal saptanarak masum üfürüm tanısı alan 30 hastadan oluşturuldu. Hasta ve kontrol gruplarının yaş ortala-maları sırasıyla 11.6±3.0 ve 11.1±3.2 yaş bulundu. Hastaların ilaç öncesi ve ilaç kullanımı sonrası çekilen EKG’leri karşılaştırıldığında yalnızca QRS aks derecesinin ilaç kullanımı ile anlamlı olarak arttığı saptandı (54.3±28.1 ve 59.2±27.8, p=0.012). İlaç kullanımı sonrası has-ta grubunun T aks derecesinin kontrol grubuna göre anlamlı olarak arttığı izlendi (44.9±15.8 ve 34.0±16.1, p=0.006). Diğer parametrelerde gruplar arasında anlamlı fark saptanmadı. Pekçok çalışmada metilfenidatın güvenli olduğu belirtilmiş olsa da özellikle aile öyküsü olan-lar ilaç kullanımı öncesi ve ilaç kullanımı sırasında klinik bulgular ve EKG ile değerlendirilmeli ve patoloji saptandığında pediatrik kardiyolog ile konsulte edilmelidir.

References

  • 1. Faraone SV, Biederman J, Friedman D. Validity of DSM-IV subtypes of attention-deficit/hyperactivity disorder: A family study perspective. J Am Acad Child Adolesc Psychiatry 2000; 39: 300-7.
  • 2. American Academy of Pediatrics, Subcommittee on Attention- Deficit/Hyperactivity Disorder and Committee on Quality Improvement. Clinical practice guideline: treatment of the schoolaged child with attentiondeficit/hyperactivity disorder. Pediatrics 2001;108: 1033–44
  • 3. Safer DJ, Malever M. Stimulant treatment in Maryland public schools. Pediatrics 2000; 106: 533–9.
  • 4. Rapport MD, Moffitt C. Attention deficit/hyperactivity disorder and methylphenidate. A review of height/weight, cardiovascular, and somatic complaint side effects. Clin Psychol Rev 2002; 22: 1107-31.
  • 5. Hii JT, Wyse G, Gillis AM et al. Precordial QT interval dispersion as a marker of torsade de pointes. Circulation 1992; 86: 1376–82.
  • 6. Somberg JS, Molnar J. Usefulness of QT dispersion as an electrocardiographically derived index. Am J Cardiol 2002; 89: 291-4.
  • 7. Leonard, BE, McCartan, D, White, J, King, DJ. Methylphenidate: a review of its neuropharmacological, neuropsychological and adverse clinical effects. Hum Psychopharmacol 2004;19: 151–80.
  • 8. Food and Drug Administration. Drug Safety and Risk Management Advisory Committee Meeting, February 9 and 10, 2006: table of contents. (Accessed March 16, 2006 at http://www.fda.gov/ohrms/dockets/ac/06/ briefing/2006 4202_00_TOC.htm.)
  • 9. Findling RL, Short EJ, Manos MJ. Short-term cardiovascular effects of methylphenidate and adderall. J Am Acad Child Adolesc Psychiatry 2001; 40: 525–9.
  • 10. Spencer T, Biederman J, Wilens T, Harding M, O’Donnell D, Griffin S. Pharmacotherapy of attentiondeficit hyperactivity disorder across the life cycle. J Am
  • Acad Child Adolesc Psychiatry 1996; 35: 409–32. 11. Shusterman V, Beigel A, Shah SI, et al. Changes in autonomic activity and ventricular repolarization. J Electrocardiol 1999; 32: 185-92.
  • 12. Pekdemir H, Toros F, Çamsarı A, Çicek D, Yurtdaş M, Parmaksız T, Katırcıbaşı T. Dikkat eksikliği hiperaktivite bozukluğu tedavisinde metilfenidat kullanımının kardiyovasküler kullanımı üzerine etkisi. Çocuk ve Gençlik Ruh Sağlığı Dergisi 2003; 10: 9-16.
  • 13. Daviss WB, Patel NC, Robb AS, et al. Clonidine for attention-deficit/hyperactivity disorder: II. ECG changes and adverse events analysis. J Am Acad Child Adolesc Psychiatry 2008; 47: 189-98.
  • 14. Gutgesell H, Atkins D, Barst R, et al. Cardiovascular monitoring of Children and Adolescents Receiving Psychotropic Drugs. Circulation 1999; 99: 979-82.
  • 15. Glauser J. Tricyclic antidepressant poisoning. Cleve Clin J Med. 2000; 67: 704-6.
  • 16. Park MK. Pediatric Cardiology for practitioners 5th ed. Philadelphia: Mosby, 2008;48-49
  • 17. Kors JA, de Bruyne MC, Hoes AW, et al. T axis as an indicator of risk of cardiac events in elderly people. Lancet 1998; 352: 601-5
  • 18. Cullen K, Stenhouse NS, Wearne KL, Cumpston GN. Electrocardiograms and 13 year cardiovascular mortality in Busselton study. Br Heart J 1982; 47: 209–12.
  • 19. Ahnve E. Correction of the QT interval for heart rate: review of different formulas and use of Bazett's Formula in myocardial infarction. Am Heart J 1985; 109: 568-72.
  • 20. Vhtatsalo M, Karjalainen J. QT interval at heart rate from 50 to 120 beats per minute during 24 hours electrocardiographic recordings in 100 healthy men: effect of atenolol. Circulation 1992; 86: 1439-45.
  • 21. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990; 63: 342-4.
  • 22. Camm AJ, Malik M, Yap YG. Risk of QT prolongation and torsades de pointes with psychotropic drugs. In: Camm AJ, Malik M, Yap YG, editors. Acquired long QT syndrome. Oxford: Blackwell Futura 2004: p. 102–20.
  • 23. Stiefel G, Besag F. Cardiovascular effects of methylphenidate, amphetamines and atomoxetine in the treatment of atention-deficit hyperactivity disorder. Drug Saf 2010; 33: 821-42.
  • 24. McNally P, McNicholas F, Oslizlok P. The QT intpsychotropic medications in children: recommendations for clinicians. Eur Child Adolesc Psychiatry. 2007; 16: 33- 47

The Evaluation of Electrocardiographic Effects of Methylphenidate in Children with Attention Deficit Hyperactivity Disorder

Year 2014, Volume: 2 Issue: 3, 99 - 103, 12.07.2016

Abstract

In recent years, the frequency of attention deficit hyperactivity disorder (ADHD) has been increasing both in children and adeloscents. Methylphenidate (MPH) is the most commonly preferred agent among child and adolescent psychiatrists in treatment of ADHD. But, cardiovascular adverse effects such as hypertension and rhythm disturbances can be seen in these patients. In this study, we aimed to assess the electrocardiographic changes after the treatment of MPH in patients with ADHD. The detailed medical history, findigs of physical examination and 12-lead electrocardiograms of forty one patients diagnosed with ADHD and referred to our pediatric cardiology outpatient clinic for cardiac evaluation before the usage of MPH were reviewed retrospectively. Kontrol grubu ise üfürüm nedeniyle değerlendirilen ve ekokardiyografileri normal saptanarak masum üfürüm tanısı alan 30 hastadan oluşturuldu. The patients evaluated for cardiac murmur and diagnosed to have innocent murmur after normal echocardiography constituted control group. The mean age of patient and control groups were 11.6±3.0 and 11.1±3.2 years, respectively. When the pre-treatment and posttreatment electrocardiograms of the patient group were compared, the only significant difference was a post-treatment increase in degree of QRS axis (54.3±28.1 ve 59.2±27.8, p=0.012). T axis was found higher in patient group after treatment compared to controls (44.9±15.8 ve 34.0±16.1, p=0.006). The other parameters did not differ between the groups. Although many studies reported that MPH is safe, the patients should be evaluated with clinical and electrocardiographic findings before initiation and during the use of MPH especially in patients with positive family history. They should be consulted by pediatric cardiologist if any pathology is found.

References

  • 1. Faraone SV, Biederman J, Friedman D. Validity of DSM-IV subtypes of attention-deficit/hyperactivity disorder: A family study perspective. J Am Acad Child Adolesc Psychiatry 2000; 39: 300-7.
  • 2. American Academy of Pediatrics, Subcommittee on Attention- Deficit/Hyperactivity Disorder and Committee on Quality Improvement. Clinical practice guideline: treatment of the schoolaged child with attentiondeficit/hyperactivity disorder. Pediatrics 2001;108: 1033–44
  • 3. Safer DJ, Malever M. Stimulant treatment in Maryland public schools. Pediatrics 2000; 106: 533–9.
  • 4. Rapport MD, Moffitt C. Attention deficit/hyperactivity disorder and methylphenidate. A review of height/weight, cardiovascular, and somatic complaint side effects. Clin Psychol Rev 2002; 22: 1107-31.
  • 5. Hii JT, Wyse G, Gillis AM et al. Precordial QT interval dispersion as a marker of torsade de pointes. Circulation 1992; 86: 1376–82.
  • 6. Somberg JS, Molnar J. Usefulness of QT dispersion as an electrocardiographically derived index. Am J Cardiol 2002; 89: 291-4.
  • 7. Leonard, BE, McCartan, D, White, J, King, DJ. Methylphenidate: a review of its neuropharmacological, neuropsychological and adverse clinical effects. Hum Psychopharmacol 2004;19: 151–80.
  • 8. Food and Drug Administration. Drug Safety and Risk Management Advisory Committee Meeting, February 9 and 10, 2006: table of contents. (Accessed March 16, 2006 at http://www.fda.gov/ohrms/dockets/ac/06/ briefing/2006 4202_00_TOC.htm.)
  • 9. Findling RL, Short EJ, Manos MJ. Short-term cardiovascular effects of methylphenidate and adderall. J Am Acad Child Adolesc Psychiatry 2001; 40: 525–9.
  • 10. Spencer T, Biederman J, Wilens T, Harding M, O’Donnell D, Griffin S. Pharmacotherapy of attentiondeficit hyperactivity disorder across the life cycle. J Am
  • Acad Child Adolesc Psychiatry 1996; 35: 409–32. 11. Shusterman V, Beigel A, Shah SI, et al. Changes in autonomic activity and ventricular repolarization. J Electrocardiol 1999; 32: 185-92.
  • 12. Pekdemir H, Toros F, Çamsarı A, Çicek D, Yurtdaş M, Parmaksız T, Katırcıbaşı T. Dikkat eksikliği hiperaktivite bozukluğu tedavisinde metilfenidat kullanımının kardiyovasküler kullanımı üzerine etkisi. Çocuk ve Gençlik Ruh Sağlığı Dergisi 2003; 10: 9-16.
  • 13. Daviss WB, Patel NC, Robb AS, et al. Clonidine for attention-deficit/hyperactivity disorder: II. ECG changes and adverse events analysis. J Am Acad Child Adolesc Psychiatry 2008; 47: 189-98.
  • 14. Gutgesell H, Atkins D, Barst R, et al. Cardiovascular monitoring of Children and Adolescents Receiving Psychotropic Drugs. Circulation 1999; 99: 979-82.
  • 15. Glauser J. Tricyclic antidepressant poisoning. Cleve Clin J Med. 2000; 67: 704-6.
  • 16. Park MK. Pediatric Cardiology for practitioners 5th ed. Philadelphia: Mosby, 2008;48-49
  • 17. Kors JA, de Bruyne MC, Hoes AW, et al. T axis as an indicator of risk of cardiac events in elderly people. Lancet 1998; 352: 601-5
  • 18. Cullen K, Stenhouse NS, Wearne KL, Cumpston GN. Electrocardiograms and 13 year cardiovascular mortality in Busselton study. Br Heart J 1982; 47: 209–12.
  • 19. Ahnve E. Correction of the QT interval for heart rate: review of different formulas and use of Bazett's Formula in myocardial infarction. Am Heart J 1985; 109: 568-72.
  • 20. Vhtatsalo M, Karjalainen J. QT interval at heart rate from 50 to 120 beats per minute during 24 hours electrocardiographic recordings in 100 healthy men: effect of atenolol. Circulation 1992; 86: 1439-45.
  • 21. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990; 63: 342-4.
  • 22. Camm AJ, Malik M, Yap YG. Risk of QT prolongation and torsades de pointes with psychotropic drugs. In: Camm AJ, Malik M, Yap YG, editors. Acquired long QT syndrome. Oxford: Blackwell Futura 2004: p. 102–20.
  • 23. Stiefel G, Besag F. Cardiovascular effects of methylphenidate, amphetamines and atomoxetine in the treatment of atention-deficit hyperactivity disorder. Drug Saf 2010; 33: 821-42.
  • 24. McNally P, McNicholas F, Oslizlok P. The QT intpsychotropic medications in children: recommendations for clinicians. Eur Child Adolesc Psychiatry. 2007; 16: 33- 47
There are 24 citations in total.

Details

Other ID JA42FM62RS
Journal Section Articles
Authors

Cem Karadeniz This is me

Arif Ruhi Özyürek This is me

Zülal Ülger This is me

Ertürk Levent This is me

Rahmi Özdemir This is me

Mustafa Orhan Bulut This is me

Publication Date July 12, 2016
Published in Issue Year 2014 Volume: 2 Issue: 3

Cite

APA Karadeniz, C., Özyürek, A. R., Ülger, Z., Levent, E., et al. (2016). Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi. Uluslararası Klinik Araştırmalar Dergisi, 2(3), 99-103.
AMA Karadeniz C, Özyürek AR, Ülger Z, Levent E, Özdemir R, Bulut MO. Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi. IJCR. July 2016;2(3):99-103.
Chicago Karadeniz, Cem, Arif Ruhi Özyürek, Zülal Ülger, Ertürk Levent, Rahmi Özdemir, and Mustafa Orhan Bulut. “Dikkat Eksikliği Ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi”. Uluslararası Klinik Araştırmalar Dergisi 2, no. 3 (July 2016): 99-103.
EndNote Karadeniz C, Özyürek AR, Ülger Z, Levent E, Özdemir R, Bulut MO (July 1, 2016) Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi. Uluslararası Klinik Araştırmalar Dergisi 2 3 99–103.
IEEE C. Karadeniz, A. R. Özyürek, Z. Ülger, E. Levent, R. Özdemir, and M. O. Bulut, “Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi”, IJCR, vol. 2, no. 3, pp. 99–103, 2016.
ISNAD Karadeniz, Cem et al. “Dikkat Eksikliği Ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi”. Uluslararası Klinik Araştırmalar Dergisi 2/3 (July 2016), 99-103.
JAMA Karadeniz C, Özyürek AR, Ülger Z, Levent E, Özdemir R, Bulut MO. Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi. IJCR. 2016;2:99–103.
MLA Karadeniz, Cem et al. “Dikkat Eksikliği Ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi”. Uluslararası Klinik Araştırmalar Dergisi, vol. 2, no. 3, 2016, pp. 99-103.
Vancouver Karadeniz C, Özyürek AR, Ülger Z, Levent E, Özdemir R, Bulut MO. Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat’ın Elektrokardiyografik Etkilerinin Değerlendirilmesi. IJCR. 2016;2(3):99-103.