Acute myocardial infarction due to spontaneous coronary artery dissection in a 6-year-old boy with ADHD on the third day of treatment with methylphenidate

Stammschulte, Thomas; Pitzer, Martina; Rascher, Wolfgang; Becker, Michael; Pohlmann, Ulrich; Ostermayer, Stefan; Kerst, Gunter

doi:10.1007/s00787-021-01729-2

Cited by 6 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A meta-analysis focusing on five studies with >43,000 children and adolescents did not find significant differences in adverse cardiac events between methylphenidate and atomoxetine. Similarly, a meta-analysis of three studies involving 775 adults did not reveal significant differences in adverse cardiac events between methylphenidate and placebo ( Stammschulte et al, 2022 ). Nonetheless, AE reports from Canada and Germany ( Wonnacott and Berringer, 2016 ; Stammschulte et al, 2022 ), including cases of acute myocardial infarction and coronary artery dissection, have raised concerns regarding the safety of these medications ( Anders and Sharfstein, 2006 ).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a meta-analysis of three studies involving 775 adults did not reveal significant differences in adverse cardiac events between methylphenidate and placebo ( Stammschulte et al, 2022 ). Nonetheless, AE reports from Canada and Germany ( Wonnacott and Berringer, 2016 ; Stammschulte et al, 2022 ), including cases of acute myocardial infarction and coronary artery dissection, have raised concerns regarding the safety of these medications ( Anders and Sharfstein, 2006 ). Furthermore, through a PubMed search, we discovered several case reports of amphetamine users experiencing coronary artery dissection, all suspected to be caused by the use of amphetamines.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Safety profiles of methylphenidate, amphetamine, and atomoxetine: analysis of spontaneous reports submitted to the food and drug administration adverse event reporting system

Wei,

Chen,

Zhou

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

Background: Methylphenidate, atomoxetine, and Amphetamine are the three most commonly used medications approved by the United States Food and Drug Administration (FDA) for the treatment of attention deficit/hyperactivity disorder (ADHD). However, a comprehensive analysis of their safety profiles across various age groups and genders in real-world contexts has yet to be conducted. In this study, a pharmacovigilance analysis was performed using the FDA Adverse Event Reporting System (FAERS) database to examine differences in adverse events between methylphenidate, atomoxetine, and Amphetamine.Methods: From January 2014 to September 2022, FAERS reports listing “Methylphenidate,” “Dexmethylphenidate,” “Atomoxetine,” “Amphetamine,” “Lisdexamfetamine,” “Dextroamphetamine,” and “Methamphetamine” as primary suspects were analyzed after removing duplicate reports. We used the standardized Medical Dictionary for Regulatory Activities (MedDRA) query generalized search for adverse events at the preferred term level based on case reports. After filtering duplicate reports, disproportionality analysis was used to detect safety signals according to the proportional reporting ratio (PRR). In order to delve into potential safety concerns, we undertook a two-step analysis of the data. Initially, the data was segmented based on age cohorts: 0–5 years, 6–12 years, 13–18 years, and individuals aged ≥19 years. Following this, after partitioning the data into males and females within the 0–18 years age group, and similarly for those aged ≥19 years, further analysis was conducted.Results: The pharmacovigilance analysis uncovered substantial safety signals in the standardized MedDRA queries. Methylphenidate was associated with dyskinesia (PRR = 21.15), myocardial infarction (PRR = 12.32), and hypertension (PRR = 8.95) in children aged 0–5, 6–12, and 13–18 years, respectively, as well as neonatal exposures via breast milk (PRR = 14.10) in adults aged ≥19 years. Atomoxetine was linked to hostility/aggression (PRR = 15.77), taste and smell disorders (PRR = 6.75), and hostility/aggression (PRR = 6.74) in children aged 0–5, 6–12, and 13–18 years, respectively, as well as hostility/aggression (PRR = 14.00) in adults aged ≥19 years. Amphetamine was associated with psychosis and psychotic disorders (PRR = 16.78), hostility/aggression (PRR = 4.39), and Other ischaemic heart disease (PRR = 10.77) in children aged 0–5 years, 6–12 years, and 13–18 years, respectively, and hostility/aggression in adults aged ≥19 years (PRR = 9.16). Significant and noteworthy adverse event signals were also identified at the preferred term level. Specifically, methylphenidate was associated with myocardial infarction, acute myocardial infarction, coronary artery dissection, electrocardiogram QT prolonged, growth retardation, self-destructive behavior, suicidal ideation, and completed suicide. Atomoxetine was linked to electrocardiogram QT prolonged, growth retardation, and tic. Amphetamine was recorded for coronary artery dissection, suicidal ideation, and completed suicide. It was observed that male patients, including both children and adults, showed a more significant and frequent occurrence of adverse events compared to females, particularly in terms of cardiac disorders. The intensity and quantity of adverse event signals were distinctly different between the two genders, with males having a higher number of signals. All detected safety signals were confirmed using signals obtained from the disproportionality analysis.Conclusion: This pharmacovigilance analysis demonstrated significant variations in the safety profiles of methylphenidate, atomoxetine, and Amphetamine across different age groups and between different genders. Following an in-depth analysis of the FAERS database, we discerned prominent safety signals. Notably, the strength of the signals associated with coronary artery dissection induced by methylphenidate and amphetamine, as well as those related to suicide, demand particular attention. Consequently, it remains imperative to persist in monitoring these medications, assessing the associated risks, and carrying out comparative studies particularly geared towards ADHD drugs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety profiles of methylphenidate, amphetamine, and atomoxetine: analysis of spontaneous reports submitted to the food and drug administration adverse event reporting system

Wei,

Chen,

Zhou

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…According to a Cochrane review, the proportion of participants on methylphenidate with chest pain was 2.20% 14. On the other hand, Stammschulte et al reported that an acute myocardial infarction (MI) may occur even without predisposing risk factors 15. In general, methylphenidate exposure in children is associated with arrhythmia 16…”

Section: Discussionmentioning

confidence: 99%

Methylphenidate-associated chest pain in a child

Masiran,

Ilias,

Yubbu

2023

BMJ Case Rep

View full text Add to dashboard Cite

A young child was diagnosed with autism spectrum disorder with comorbid attention-deficit/hyperactivity disorder. His hyperactivity, impulsivity and absence of awareness towards danger increased his risk of harm and hence methylphenidate was indicated. Unfortunately, he developed chest pain eight months after the treatment initiation. We then stopped the stimulant and changed his treatment to atomoxetine, after which he no longer had chest pain. In the following illustrated case, we will discuss the cardiac side effect of methylphenidate.

show abstract

“…Only 7 cases of SCAD in the under 19 population have been identified in the existing peer-reviewed literature (Table 2 ). In 4 of the 7 published cases, chest pain was the first clinical symptom of SCAD[ 17 - 20 ]. However, one other case of SCAD in an 18-year-old boy was asymptomatic[ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…SCAD has been described in 2 case reports of adolescent patients; one with neurofibromatosis type I[ 17 ] and one with systemic lupus erythematosus[ 22 ]. Acute triggering events involving the consumption of a caffeine -containing beverage[ 18 ], heavy exercise[ 19 ] and the use of methylphenidate[ 20 ] are suspected causes of SCAD. In one case, details of possible triggers and symptoms were not mentioned[ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous dissection of proximal left main coronary artery in a healthy adolescent presenting with syncope: A case report

Liu¹,

Jia²,

Ma³

et al. 2022

WJCC

View full text Add to dashboard Cite

BACKGROUND Spontaneous coronary artery dissection (SCAD) is a frequent cause of acute coronary syndrome in young to middle-aged women with few or no traditional cardiovascular risk factors. Chest pain is the most frequently described presenting symptom, but syncope is extremely rare. Herein, we report on a 16-year-old girl who presented with an episode of syncope occurring during a race. Despite significantly elevated troponin level, the diagnosis of the left main coronary artery SCAD with cardiogenic shock was delayed. CASE SUMMARY A 16-year-old girl presented with an episode of syncope. Myocardial injury markers were positive. Echocardiography showed a mildly reduced left ventricular ejection fraction (50%). Although initially stable, she later experienced recurrent chest pain accompanying precordial ST segment elevation with dynamic changes and developed cardiogenic shock, necessitating emergent revascularization. Coronary angiography demonstrated almost total occlusion at the ostium and proximal segment of the left main trunk coronary artery (LMT). Intravascular ultrasound confirmed a false lumen with prominent dissection in the LMT. Percutaneous coronary intervention assisted by intra-aortic balloon pump was conducted in the LMT. A 3.5 mm × 24 mm everolimus-eluting stent was deployed to the focal lesions of the LMT. A postprocedural electrocardiogram showed alleviation of the precordial ST-segment elevation. The diagnosis of SCAD was confirmed. Transthoracic echocardiography showed an improved left ventricular ejection fraction (57%). The patient was asymptomatic during the 24-mo. follow-up period. CONCLUSION SCAD should always be considered in the differential diagnosis of acute coronary syndrome presentations in low-risk patients, regardless of age.

show abstract

Acute myocardial infarction due to spontaneous coronary artery dissection in a 6-year-old boy with ADHD on the third day of treatment with methylphenidate

Cited by 6 publications

References 19 publications

Safety profiles of methylphenidate, amphetamine, and atomoxetine: analysis of spontaneous reports submitted to the food and drug administration adverse event reporting system

Safety profiles of methylphenidate, amphetamine, and atomoxetine: analysis of spontaneous reports submitted to the food and drug administration adverse event reporting system

Methylphenidate-associated chest pain in a child

Spontaneous dissection of proximal left main coronary artery in a healthy adolescent presenting with syncope: A case report

Contact Info

Product

Resources

About