Evaluation of acute cardiovascular effects of immediate-release methylphenidate in children and adolescents with attention-deficit hyperactivity disorder

Marco Lamberti,^1,2 Domenico Italiano,² Laura Guerriero,¹ Gessica D’Amico,³ Rosamaria Siracusano,^1,4 Massimo Ingrassia,⁵ Eva Germanò,¹ Maria Pia Calabrò,³ Edoardo Spina,² Antonella Gagliano<sup>1

1</sup>Division of Child Neurology and Psychiatry, Department of Pediatrics, ²Department of Clinical and Experimental Medicine, ³Division of Pediatric Cardiology, Department of Pediatrics, University of Messina, Messina, Italy; ⁴Institution of Clinical Physiology, CNR, Pisa, ⁵Division of Psychology, Department of Humanities and Social Sciences, University of Messina, Messina, Italy

Abstract: Attention-deficit hyperactivity disorder is a frequent condition in children and often extends into adulthood. Use of immediate-release methylphenidate (MPH) has raised concerns about potential cardiovascular adverse effects within a few hours after administration. This study was carried out to investigate acute effects of MPH on electrocardiogram (ECG) in a pediatric population. A total of 54 consecutive patients with attention-deficit hyperactivity disorder (51 males and 3 females; mean age =12.14±2.6 years, range 6–19 years), receiving a new prescription of MPH, underwent a standard ECG 2 hours before and after the administration of MPH 10 mg per os. Basal and posttreatment ECG parameters, including mean QT (QT interval when corrected for heart rate [QTc]), QTc dispersion (QTd) interval duration, T-peak to T-end (TpTe) intervals, and TpTe/QT ratio were compared. Significant modifications of both QTc and QTd values were not found after drug administration. QTd fluctuated slightly from 25.7±9.3 milliseconds to 25.1±8.4 milliseconds; QTc varied from 407.6±12.4 milliseconds to 409.8±12.7 milliseconds. A significant variation in blood pressure (systolic blood pressure 105.4±10.3 vs 109.6±11.5; P<0.05; diastolic blood pressure 59.2±7.1 vs 63.1±7.9; P<0.05) was observed, but all the data were within normal range. Heart rate moved from 80.5±15.5 bpm to 87.7±18.8 bpm. No change in TpTe values was found, but a statistically significant increase in TpTe/QTc intervals was found with respect to basal values (0.207±0.02 milliseconds vs 0.214±0.02 milliseconds; P<0.01). The findings of this study show no significant changes in ECG parameters. TpTe values can be an additional parameter to evaluate borderline cases.

Keywords: ADHD, methylphenidate, cardiovascular effects, children, adolescents