Local Hospital Study on Safety of Attention Deficit Hyperactivity Disorder Medication in Children and Adolescents

Abstract Description

Authors (including presenting author) :

Poon HL (1)(2)

Affiliation :

(1) Pharmacy Department, United Christian Hospital (2) School of Pharmacy, The Chinese University of Hong Kong

Keyword 1: :

Attention Deficit Hyperactivity Disorder

Keyword 2: :

Methylphenidate

Keyword 3: :

Lisdexamfetamine

Keyword 4: :

Atomoxetine

Keyword 5: :

NULL

Keyword 6: :

NULL

Introduction :

Attention-Deficit/ Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in children. International guidelines recommend using medication to improve learning performance and social behaviors. However, side effect profiles regarding growth, cardiovascular, and psychiatric effects have always been a concern to parents.

Objectives :

This study aims to investigate which ADHD medications would lead to a higher prevalence of growth retardation and other adverse effects in pediatric patients and to determine the effectiveness of adjunctive treatment to ADHD medications in improving adverse effects.

Methodology :

The study was conducted at a local hospital of the Hospital Authority (HA). Patients who had been prescribed with methylphenidate, lisdexamfetamine, or atomoxetine for at least one year were included. The growth effects of ADHD medications were assessed using the Z-score of height, weight, and BMI calculated by the LMS method (abbreviation refers to smooth curve-L, mean-M, and coefficient of variation-S; Cole, 1990) before treatment initiation and subsequently 12 months later.

Result & Outcome :

Of the 150 patients included (116 boys, 34 girls; mean age at first dispense [SD], 9.4 [2.3] years, 103 were on methylphenidate (68.7%), 38 were on lisdexamfetamine (25.3%), and only 9 were on atomoxetine (6.0%). Mean growth Z-scores were reduced with methylphenidate (height, Δ = -0.083, p = 0.017, 95% CI -0.152 – -0.015; weight, Δ = –0.241, p < 0.001, 95% CI -0.337 – -0.145; BMI, Δ = –0.214, p < 0.001, 95% CI -0.315 – -0.115) and lisdexamfetamine (height, Δ = -0.162, p = 0.206, 95% CI -0.418 – 0.093; weight, Δ = -0.168, p = 0.258, 95% CI -0.466 – 0.129; BMI, Δ = -0.053, p = 0.599, 95% CI -0.256 – 0.149) but improved with atomoxetine (height, Δ = + 0.157, p = 0.153, 95% CI -0.072 – 0.386; weight, Δ = +0.269, p = 0.067, 95% CI -0.024 – 0.563; BMI, Δ = +0.192, p = 0.166, 95% CI -0.099 – 0.484). Statistically significant reductions in growth Z-scores were only seen in the methylphenidate intention-to-treat group and in Z-scores (heights, weight) of the lisdexamfetamine per-protocol group. Regarding adjunctive treatment, there were no statistically significant differences in the change in growth Z-scores with the use of melatonin, cyproheptadine, or drug holidays. Methylphenidate use in ADHD children was associated with a reduction in height, weight, and BMI, while lisdexamfetamine also showed a minimal drop in height and weight. Adjunctive drug holiday, cyproheptadine, and melatonin did not cause a significant difference in alleviating the growth effect of stimulants.