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Abstract

Methylphenidate treatment of ADHD in adults was associated with an increase in sudden death from ventricular arrhythmia, from 1 death per 1,000 person-years to 2 deaths. The effect was more marked at lower rather than higher doses, suggesting that lower doses may have been prescribed to individuals with preexisting cardiovascular risk factors. There was no increase in strokes or myocardial infarctions.

Abstract

Objective:

The authors sought to determine whether use of methylphenidate in adults is associated with elevated rates of serious cardiovascular events compared with rates in nonusers.

Method:

This was a cohort study of new users of methylphenidate based on administrative data from a five-state Medicaid database and a 14-state commercial insurance database. All new methylphenidate users with at least 180 days of prior enrollment were identified. Users were matched on data source, state, sex, and age to as many as four comparison subjects who did not use methylphenidate, amphetamines, or atomoxetine. A total of 43,999 new methylphenidate users were identified and matched to 175,955 nonusers. Events of primary interest were 1) sudden death or ventricular arrhythmia, 2) stroke, 3) myocardial infarction, and 4) a composite endpoint of stroke or myocardial infarction.

Results:

The age-standardized incidence rate per 1,000 person-years of sudden death or ventricular arrhythmia was 2.17 (95% CI=1.63–2.83) in methylphenidate users and 0.98 (95% CI=0.89–1.08) in nonusers, for an adjusted hazard ratio of 1.84 (95% CI=1.33–2.55). Dosage was inversely associated with risk. Adjusted hazard ratios for stroke, myocardial infarction, and the composite endpoint of stroke or myocardial infarction did not differ statistically from 1.

Conclusions:

Although initiation of methylphenidate was associated with a 1.8-fold increase in risk of sudden death or ventricular arrhythmia, the lack of a dose-response relationship suggests that this association may not be a causal one.

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Supplementary Material

File (appi.ajp.2011.11010125.ds001.pdf)

Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 178 - 185
PubMed: 22318795

History

Revision received: 2 January 2011
Received: 23 January 2011
Revision received: 6 July 2011
Revision received: 12 October 2011
Accepted: 4 November 2011
Published online: 1 February 2012
Published in print: February 2012

Authors

Affiliations

Hedi Schelleman, Ph.D.
From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.
Warren B. Bilker, Ph.D.
From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.
Stephen E. Kimmel, M.D., M.S.C.E.
From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.
Gregory W. Daniel, R.Ph., Ph.D.
From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.
Craig Newcomb, M.S.
From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.
James P. Guevara, M.D., M.P.H.
From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.
Mark J. Cziraky, Pharm.D., C.L.S.
From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.
Brian L. Strom, M.D., M.P.H.
From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.
Sean Hennessy, Pharm.D., Ph.D.
From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.

Notes

Address correspondence to Dr. Hennessy ([email protected]).

Funding Information

From the Center for Clinical Epidemiology and Biostatistics, the Department of Biostatistics and Epidemiology, and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; HealthCore, Inc., Wilmington, Del.; and PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia.All authors received salary support from Shire through their employer. Dr. Schelleman has had travel to scientific conferences paid for by University of Pennsylvania's pharmacoepidemiology training program through funds contributed by Abbott, Amgen, Hoffman LaRoche, Novartis, Pfizer, Sanofi Pasteur, and Wyeth. Dr. Bilker has consulted for Johnson & Johnson. Dr. Kimmel has received grant funding or consulting fees from the Aetna Foundation, AstraZeneca, Bristol-Myers Squibb, Centocor, Johnson & Johnson, Novartis, Merck, and Pfizer. Drs. Daniel and Cziraky are employed by HealthCore, Inc., which conducts research for and receives funding from pharmaceutical manufacturers for research services. Dr. Strom has received research support from or consulted for Abbott, Amgen, AstraZeneca, BMS, Boehringer Ingelheim, GlaxoSmithKline, Novartis, NPS Pharma, Nuvo Research, Orexigen, Pfizer, Shire, Takeda, Teva, and Vivus and has received contributions to University of Pennsylvania's pharmacoepidemiology training program from Abbott, Amgen, Hoffman LaRoche, Novartis, Pfizer, Sanofi Pasteur, and Wyeth. Dr. Hennessy has received grant funding from Abbott and has consulted for Abbott and Teva.Funded through a sponsored research agreement with Shire Development, Inc., with infrastructure support provided by NIH (Clinical and Translational Science Award 5KL2RR024132).

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