The Attention Deficit and Hyperactivity Disorder (ADHD) is a rare disease that should not be confused with emotional upheavals originated by lack of affection or attention in the house, bullying at school or incompetent teachers.

The 9th of February of this year, the consultative Committee on Handling of the Risk and Drug Security of the FDA (Food and Drug Administration) voted by a narrow margin of 8 to 7 the recommendation to place a label that describes the cardiovascular risks of use of these drugs to treat ADD.

This decision was unexpected mainly because the FDA had not requested a review of the present label of this type of drugs. It only requested recommendations in relation to the cardiovascular risks associated with them.

The Committee analyzed a document prepared by the Adverse Events Reports System (AERS) subscribed to the FDA in where cases of sudden death had been registered, infarct to the myocardium, arrhythmias, and Cerebral Vascular Accidents (ACV) in children and adults who received stimulants for the treatment of ADHD.

File and Uses:

The drugs submitted to review were: Amphetamines (Adderal) and Methylphenidate (Ritalin, Concerta). These types of medicines are powerful stimulants of the Central and Cardiovascular Nervous System. One of oldest amines Methamphetamine was developed in 1891 and widely used during World War II in Nazi Germany to improve the ability and alert status of the pilots. The medical use of these drugs had been limited, whereas the illicit use has increased, until becoming a public health problem. Inhaled or injected, Methamphetamine (speed) is associated with sudden death, infarct to the myocardium, and CVA.  

At the beginning of 1950's dextroamphetamine was promoted as an appetite suppressor agent.

Definition and Epidemiology:

ADHD is commonly diagnosed in children in school age which is usually characterized by increase in the activity, inability to concentrate, and poor scholastic achievement. Amphetamines and similar stimulants have been used to treat this disease since 1950 and its use has increased in recent years.

The consultative committee of the FDA has listened to testimonies indicating that 2.5 million children nowadays receive stimulants to treat ADHD, including nearly 10% of the children of 10 years of age in the United States . The use of these stimulants is less frequent in Europe , where the ADHD diagnosis is less common. It is equally surprising that 1.5 million adults take these stimulants on a daily basis.

Cardiovascular effects

Amphetamines' effects at the cardiovascular level are widely described in the medical literature. These substances increase the cardiac frequency and arterial tension. Controlled placebo studies have demonstrated that amphetamines (Adderal) and Methylphenidate (Ritalin) increase the arterial pressure. The long term changes in the arterial pressure increase the morbidity and mortality.