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Dikkat Eksikliği Hiperaktivite Bozukluğu Olan Çocuklarda Metilfenidat Kullanımına Bağlı Erken Kardiyovasküler Değişikliklerin Değerlendirilmesi

Yıl 2013, Cilt: 7 Sayı: 3, 119 - 123, 01.10.2013

Öz

Amaç: Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB) tanısı ile metilfenidat kullanan hastalarda sık olmasa bile kardiyovasküler yan etkiler görülebilmektedir. Bu konu ile ilgili literatürde az sayıda çalışma bulunmaktadır. Bu çalışma ile DEHB olan çocuklarda metilfenidat kullanımının kardiyovasküler sistem üzerindeki etkilerini araştırmayı planladık. Gereç ve Yöntemler: Hastanemiz Çocuk Psikiyatrisi Kliniği tarafından Mayıs 2011-Mayıs 2012 tarihleri arasında DEHB tanısı ile metilfenidat tedavisi başlanan 141 hasta incelendi. Tedavinin ilk bir ayında kardiyovasküler semptom tariflemiş olan otuz hastaya ait demografik özellikler, kalp hızı, sistolik ve diyastolik kan basıncı, elektrokardiyografi (EKG) ile QTc süresi ve 24 saatlik ritim Holter sonuçları retrospekfik olarak değerlendirildi. Bulgular: Değerlendirilen 30 hastanın (8 kız, 22 erkek) yaş ortalaması kızlarda 10±3 yaş iken erkeklerde 9±2.2 yaştı. Tedavinin 1. ayında ortalama QTc süreleri hastalarda artmış olarak saptandı ve istatistiksel olarak anlamlı bulundu. Fakat hiçbir hastada QTc süresindeki uzama patolojik düzeyde değildi. Kız hastaların ortalama sistolik ve diyastolik kan basınçlarında ilk ayın sonunda artma olmasına rağmen istatistiksel olarak anlamlı bulunmadı. Benzer şekilde hastaların ortalama kalp hızlarında da artış vardı, ancak istatistiksel olarak anlamlı değildi. Başlıca semptomlar 14 hastada (%46.6) çarpıntı, 10 hastada (%33.4) göğüs ağrısı, 4 hastada (%13.4) çarpıntı ve göğüs ağrısı ve 2 hastada (%6.6) nefes darlığı idi. Bu hastaların tümünde EKG ve 24 saatlik ritim Holter sonuçlarının normal olduğu, ancak iki hastada tetkik sonuçları normal olmasına rağmen ailelerinin isteği ile tedavinin sonlandırıldığı görüldü. Sonuç: Bu çalışmada, metilfenidat tedavisinin kardiyovasküler sistem üzerine etkileri ortaya konulmaya çalışıldı. QTc süresinde uzamanın istatistiksel olarak anlamlı olduğu, ancak bu uzamanın patolojik sınırları geçmediği görüldü.

Kaynakça

  • Tannock R. Attention deficit hyperactivity disorder: Advances in cognitive, neurobiological, and genetic research. J Child Psychol Psychiatry 1998;39:65-99.
  • Schweitzer JB, Faber TL, Grafton ST, Tune LE, Hoffman JM, Kilts CD. Alterations in the functional anatomy of working memory in adult attention defisit hyperactivity disorder. Am J Psychiatry 2000;157:278-80.
  • Weiss G. Attention deficit hyperactivity disorders. In Lewis M (ed). Child and Adolescent Psychiatry: A Compherensive Textbook. Baltimore: Lippincott Williams and Wilkins, 1990.
  • American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders-Revised. DSM IV Tanı Ölçütleri, Çev. E. Köroğlu. Ankara: Hekimler Yayın Birliği, 1994:129-30.
  • Steven EN. ADHD drugs and cardiovascular risk. N Eng J Med 2006;354:14-20.
  • Rapport MD, Moffitt C. Attention deficit/hyperactivity disorder and metylphenidate. A review of height/weight, cardiovascular, and somotic complaint side effects. Clin Psychol Rev 2002;22: 1107-31.
  • Volkow ND, Wang GJ, Fowler JS, Molina PE, Logan J, Gatley SJ, et al. Cardiovascular effect of methylphenidate in humans are associated with increases of dopamine in brain and of epinehrine in plasma. Psychopharmacology 2003;166:264-70.
  • Lucas PB, Gardner DL, Wolkowitz OM, Tucker EE, Cowdry RD. Methylphenidate induced cardiac arhythmias. N Engl J Med 1986;315:1485.
  • Shimizu W. Effects of sympathetic stimulation on various repolarization indicis in the congenital long QT syndrome. Ann Noninvasive Electrocardiol 2002;7:332-42.
  • Weis M, Weis G. Attention deficit hyperactivity disorder. In Lewis M (ed). Child and Adolescent Psychiatri (3rd ed). Baltimore: Lippincott Williams and Wilkins, 2002;645-70.
  • Şener S, Şenol S, Karacan E. Çocukluk ergenlik çağı psikofarmakolojisi. İçinde: Yüksel N (ed). Psikofarmakoloji 2. ed. Ankara:Çizgi Tıp Yayınevi, 2003;427-61.
  • Vitello B, Elliott GR, Swanson JM, Arnold LE, Hechtman L, Abikoff H, et al. Blood pressure and heart rate over 10 years in the multimodal treatment study of children with ADHD. Am J Psychiatry 2012:169;167-77.
  • Nahshoni E, Spitzer S, Berant M, Shoval G, Zalsman G, Weizman A. QT interval and dispersion in very young children treated with antipsychotic drugs: A retrospective chart review. J Child Adolesc Psychopharmacol 2007:17;187-94.
  • 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.
  • Hill SL, El-Khayat RH, Sandilands EA, Thomas SH. Electrocardi- ographic effects of methylphenidate overdose. Clin Toxicol 2010: 48;342-6.
  • Wakamatsu A, Nomura S, Tate Y, Shimizu S, Harada Y. Effects of methylphenidate hydrochloride on the cardiovascular system in vivo and in vitro: A safety pharmacology study. J Pharmacol Toxicol Methods 2009:59;128-34.

The Assessment of Early Cardiovascular Alterations due to the Use of Methylphenidate in Patients with Attention Deficit and Hyperactivity Disorder

Yıl 2013, Cilt: 7 Sayı: 3, 119 - 123, 01.10.2013

Öz

Objective: Some cardiovascular side effects can be seen in patients receiving methylphenidate treatment with a diagnosis of attention deficit and hyperactivity disorder (ADHD), although not frequent. There are few studies in the literature conducted in these patients about this issue. We aimed to investigate the early effects of methylphenidate on the cardiovascular system in children with ADHD in this study. Material and Methods: We analyzed 141 patients receiving methylphenidate treatment for ADHD in the pediatric psychiatry clinic of our hospital between May 2011 and May 2012. We retrospectively evaluated the demographic characteristics, heart rate, systolic and diastolic blood pressures, QTc duration at electrocardiogram (ECG) and 24-hour rhythm Holter results of thirty patients who had cardiovascular symptoms in the first month of treatment.Results: We evaluated a total of 30 patients (8 female and 22 male) with a mean age of 10±3 years for females and 9±2.2 years for males. The mean QTc duration increased at the end of the first month of treatment and the change was statistically significant. However, no patient had pathological prolongation of QTc duration. Although the mean systolic and diastolic blood pressures increased in female patients at the end of first month, this increase was not statistically significant. Similarly, there was an increase in the mean heart rates of the patients at the end of first month, but it was not statistically significant. The main symptoms of the patients were palpitation in 14 patients (46, 6%), chest pain in 10 patients (33.4%), palpitation and chest pain in 4 patients (13,4%) and dyspnea in 2 patients (6.6%). ECG and 24-hour rhythm Holter monitoring findings were normal in all patients. However, methylphenidate treatment was terminated in two patients because of the request of their families despite completely normal test results.Conclusion: This study was performed to demonstrate the early effects of methylphenidate treatment on the cardiovascular system in ADHD patients. This treatment caused prolongation of QTc duration, which was statistically significant but within normal ranges

Kaynakça

  • Tannock R. Attention deficit hyperactivity disorder: Advances in cognitive, neurobiological, and genetic research. J Child Psychol Psychiatry 1998;39:65-99.
  • Schweitzer JB, Faber TL, Grafton ST, Tune LE, Hoffman JM, Kilts CD. Alterations in the functional anatomy of working memory in adult attention defisit hyperactivity disorder. Am J Psychiatry 2000;157:278-80.
  • Weiss G. Attention deficit hyperactivity disorders. In Lewis M (ed). Child and Adolescent Psychiatry: A Compherensive Textbook. Baltimore: Lippincott Williams and Wilkins, 1990.
  • American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders-Revised. DSM IV Tanı Ölçütleri, Çev. E. Köroğlu. Ankara: Hekimler Yayın Birliği, 1994:129-30.
  • Steven EN. ADHD drugs and cardiovascular risk. N Eng J Med 2006;354:14-20.
  • Rapport MD, Moffitt C. Attention deficit/hyperactivity disorder and metylphenidate. A review of height/weight, cardiovascular, and somotic complaint side effects. Clin Psychol Rev 2002;22: 1107-31.
  • Volkow ND, Wang GJ, Fowler JS, Molina PE, Logan J, Gatley SJ, et al. Cardiovascular effect of methylphenidate in humans are associated with increases of dopamine in brain and of epinehrine in plasma. Psychopharmacology 2003;166:264-70.
  • Lucas PB, Gardner DL, Wolkowitz OM, Tucker EE, Cowdry RD. Methylphenidate induced cardiac arhythmias. N Engl J Med 1986;315:1485.
  • Shimizu W. Effects of sympathetic stimulation on various repolarization indicis in the congenital long QT syndrome. Ann Noninvasive Electrocardiol 2002;7:332-42.
  • Weis M, Weis G. Attention deficit hyperactivity disorder. In Lewis M (ed). Child and Adolescent Psychiatri (3rd ed). Baltimore: Lippincott Williams and Wilkins, 2002;645-70.
  • Şener S, Şenol S, Karacan E. Çocukluk ergenlik çağı psikofarmakolojisi. İçinde: Yüksel N (ed). Psikofarmakoloji 2. ed. Ankara:Çizgi Tıp Yayınevi, 2003;427-61.
  • Vitello B, Elliott GR, Swanson JM, Arnold LE, Hechtman L, Abikoff H, et al. Blood pressure and heart rate over 10 years in the multimodal treatment study of children with ADHD. Am J Psychiatry 2012:169;167-77.
  • Nahshoni E, Spitzer S, Berant M, Shoval G, Zalsman G, Weizman A. QT interval and dispersion in very young children treated with antipsychotic drugs: A retrospective chart review. J Child Adolesc Psychopharmacol 2007:17;187-94.
  • 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.
  • Hill SL, El-Khayat RH, Sandilands EA, Thomas SH. Electrocardi- ographic effects of methylphenidate overdose. Clin Toxicol 2010: 48;342-6.
  • Wakamatsu A, Nomura S, Tate Y, Shimizu S, Harada Y. Effects of methylphenidate hydrochloride on the cardiovascular system in vivo and in vitro: A safety pharmacology study. J Pharmacol Toxicol Methods 2009:59;128-34.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Diğer ID JA78HJ83UM
Bölüm Research Article
Yazarlar

Mehmet Emre Arı Bu kişi benim

İbrahim İlker Çetin Bu kişi benim

Filiz Ekici Bu kişi benim

Abdullah Kocabaş Bu kişi benim

Sancar Eminoğlu Bu kişi benim

Esra Güney Bu kişi benim

Önder Öztürk Bu kişi benim

Gülser Şenses Dinç Bu kişi benim

Zeynep Göker Bu kişi benim

Yayımlanma Tarihi 1 Ekim 2013
Gönderilme Tarihi 1 Ekim 2013
Yayımlandığı Sayı Yıl 2013 Cilt: 7 Sayı: 3

Kaynak Göster

Vancouver Arı ME, Çetin İİ, Ekici F, Kocabaş A, Eminoğlu S, Güney E, Öztürk Ö, Dinç GŞ, Göker Z. The Assessment of Early Cardiovascular Alterations due to the Use of Methylphenidate in Patients with Attention Deficit and Hyperactivity Disorder. Türkiye Çocuk Hast Derg. 2013;7(3):119-23.

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