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<blockquote data-quote="smallworld" data-source="post: 312617" data-attributes="member: 2423"><p>My own son took Concerta (long-acting methylphenidate or Ritalin) from spring 2003 to fall 2005. He had an EKG during that time, and his growth was monitored because he was at the 5th percentile for height prior to starting to treatment.</p><p> </p><p>I am not an apologist for the FDA or the drug companies, but this is the warning information taken from <a href="http://www.rxlist.com" target="_blank">www.rxlist.com</a> on Ritalin:</p><p> </p><p><strong>Serious Cardiovascular Events</strong></p><p></p><p><strong><em>Sudden Death and Pre-Existing Structural Cardiac Abnormalities or Other Serious Heart Problems</em></strong></p><p><strong>Children and Adolescents</strong></p><p></p><p>Sudden death has been reported in association with <a href="http://www.rxlist.com/script/main/art.asp?articlekey=2765" target="_blank"><u><span style="color: #0000ff">CNS</span></u></a> stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems. Although some serious heart problems alone carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known serious structural cardiac abnormalities, <a href="http://www.rxlist.com/script/main/art.asp?articlekey=13590" target="_blank"><u><span style="color: #0000ff">cardiomyopathy</span></u></a>, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug.</p><p><strong>Adults</strong></p><p></p><p>Sudden death, stroke, and <a href="http://www.rxlist.com/script/main/art.asp?articlekey=26016" target="_blank"><u><span style="color: #0000ff">myocardial infarction</span></u></a> have been reported in adults taking stimulant drugs at usual doses for <a href="http://www.rxlist.com/script/main/art.asp?articlekey=22328" target="_blank"><u><span style="color: #0000ff">ADHD</span></u></a>. Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, <a href="http://www.rxlist.com/script/main/art.asp?articlekey=10267" target="_blank"><u><span style="color: #0000ff">coronary artery disease</span></u></a>, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugs.</p><p><strong><em>Hypertension and Other Cardiovascular Conditions</em></strong></p><p>Stimulant medications cause a modest increase in average <a href="http://www.rxlist.com/script/main/art.asp?articlekey=2486" target="_blank"><u><span style="color: #0000ff">blood pressure</span></u></a> (about 2-4 mmHg) and average heart rate (about 3-6 bpm), and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia.</p><p><strong><em>Assessing Cardiovascular Status in Patients being Treated with Stimulant Medications</em></strong></p><p>Children, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e.g., <a href="http://www.rxlist.com/script/main/art.asp?articlekey=3212" target="_blank"><u><span style="color: #0000ff">electrocardiogram</span></u></a> and echocardiogram). Patients who develop symptoms such as exertional <a href="http://www.rxlist.com/script/main/art.asp?articlekey=2700" target="_blank"><u><span style="color: #0000ff">chest pain</span></u></a>, unexplained <a href="http://www.rxlist.com/script/main/art.asp?articlekey=5612" target="_blank"><u><span style="color: #0000ff">syncope</span></u></a>, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation.</p><p><strong>Psychiatric Adverse Events</strong></p><p></p><p><strong>Pre-Existing Psychosis</strong></p><p></p><p>Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder.</p><p><strong>Bipolar Illness</strong></p><p></p><p>Particular care should be taken in using stimulants to treat ADHD in patients with comorbid <a href="http://www.rxlist.com/script/main/art.asp?articlekey=2468" target="_blank"><u><span style="color: #0000ff">bipolar disorder</span></u></a> because of concern for possible induction of a mixed/ manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and <a href="http://www.rxlist.com/script/main/art.asp?articlekey=2947" target="_blank"><u><span style="color: #0000ff">depression</span></u></a>.</p><p><strong>Emergence of New Psychotic or Manic Symptoms</strong></p><p></p><p>Treatment emergent psychotic or manic symptoms, e. g., hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple short-term, <a href="http://www.rxlist.com/script/main/art.asp?articlekey=38699" target="_blank"><u><span style="color: #0000ff">placebo-controlled</span></u></a> studies, such symptoms occurred in about 0.1% (4 patients with events out of 3,482 exposed to methylphenidate or <a href="http://www.rxlist.com/script/main/art.asp?articlekey=20575" target="_blank"><u><span style="color: #0000ff">amphetamine</span></u></a> for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.</p><p><strong>Aggression</strong></p><p></p><p>Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility.</p><p><strong>Long-Term Suppression of Growth</strong></p><p></p><p>Careful follow-up of weight and height in children ages 7 to 10 years who were randomized to either methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication treated children over 36 months (to the ages of 10 to 13 years), suggests that consistently medicated children (i.e., treatment for 7 days per week throughout the year) have a temporary slowing in growth rate (on average, a total of about 2 cm less <a href="http://www.rxlist.com/script/main/art.asp?articlekey=33651" target="_blank"><u><span style="color: #0000ff">growth in height</span></u></a> and 2.7 kg less growth in weight over 3 years), without evidence of growth rebound during this period of development. Published data are inadequate to determine whether chronic use of amphetamines may cause a similar suppression of growth, however, it is anticipated that they likely have this effect as well. Therefore, growth should be monitored during treatment with stimulants, and patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted.</p></blockquote><p></p>
[QUOTE="smallworld, post: 312617, member: 2423"] My own son took Concerta (long-acting methylphenidate or Ritalin) from spring 2003 to fall 2005. He had an EKG during that time, and his growth was monitored because he was at the 5th percentile for height prior to starting to treatment. I am not an apologist for the FDA or the drug companies, but this is the warning information taken from [URL="http://www.rxlist.com"]www.rxlist.com[/URL] on Ritalin: [B]Serious Cardiovascular Events[/B] [B][I]Sudden Death and Pre-Existing Structural Cardiac Abnormalities or Other Serious Heart Problems[/I][/B] [B]Children and Adolescents[/B] Sudden death has been reported in association with [URL="http://www.rxlist.com/script/main/art.asp?articlekey=2765"][U][COLOR=#0000ff]CNS[/COLOR][/U][/URL] stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems. Although some serious heart problems alone carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known serious structural cardiac abnormalities, [URL="http://www.rxlist.com/script/main/art.asp?articlekey=13590"][U][COLOR=#0000ff]cardiomyopathy[/COLOR][/U][/URL], serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug. [B]Adults[/B] Sudden death, stroke, and [URL="http://www.rxlist.com/script/main/art.asp?articlekey=26016"][U][COLOR=#0000ff]myocardial infarction[/COLOR][/U][/URL] have been reported in adults taking stimulant drugs at usual doses for [URL="http://www.rxlist.com/script/main/art.asp?articlekey=22328"][U][COLOR=#0000ff]ADHD[/COLOR][/U][/URL]. Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, [URL="http://www.rxlist.com/script/main/art.asp?articlekey=10267"][U][COLOR=#0000ff]coronary artery disease[/COLOR][/U][/URL], or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugs. [B][I]Hypertension and Other Cardiovascular Conditions[/I][/B] Stimulant medications cause a modest increase in average [URL="http://www.rxlist.com/script/main/art.asp?articlekey=2486"][U][COLOR=#0000ff]blood pressure[/COLOR][/U][/URL] (about 2-4 mmHg) and average heart rate (about 3-6 bpm), and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia. [B][I]Assessing Cardiovascular Status in Patients being Treated with Stimulant Medications[/I][/B] Children, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e.g., [URL="http://www.rxlist.com/script/main/art.asp?articlekey=3212"][U][COLOR=#0000ff]electrocardiogram[/COLOR][/U][/URL] and echocardiogram). Patients who develop symptoms such as exertional [URL="http://www.rxlist.com/script/main/art.asp?articlekey=2700"][U][COLOR=#0000ff]chest pain[/COLOR][/U][/URL], unexplained [URL="http://www.rxlist.com/script/main/art.asp?articlekey=5612"][U][COLOR=#0000ff]syncope[/COLOR][/U][/URL], or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation. [B]Psychiatric Adverse Events[/B] [B]Pre-Existing Psychosis[/B] Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder. [B]Bipolar Illness[/B] Particular care should be taken in using stimulants to treat ADHD in patients with comorbid [URL="http://www.rxlist.com/script/main/art.asp?articlekey=2468"][U][COLOR=#0000ff]bipolar disorder[/COLOR][/U][/URL] because of concern for possible induction of a mixed/ manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and [URL="http://www.rxlist.com/script/main/art.asp?articlekey=2947"][U][COLOR=#0000ff]depression[/COLOR][/U][/URL]. [B]Emergence of New Psychotic or Manic Symptoms[/B] Treatment emergent psychotic or manic symptoms, e. g., hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple short-term, [URL="http://www.rxlist.com/script/main/art.asp?articlekey=38699"][U][COLOR=#0000ff]placebo-controlled[/COLOR][/U][/URL] studies, such symptoms occurred in about 0.1% (4 patients with events out of 3,482 exposed to methylphenidate or [URL="http://www.rxlist.com/script/main/art.asp?articlekey=20575"][U][COLOR=#0000ff]amphetamine[/COLOR][/U][/URL] for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients. [B]Aggression[/B] Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility. [B]Long-Term Suppression of Growth[/B] Careful follow-up of weight and height in children ages 7 to 10 years who were randomized to either methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication treated children over 36 months (to the ages of 10 to 13 years), suggests that consistently medicated children (i.e., treatment for 7 days per week throughout the year) have a temporary slowing in growth rate (on average, a total of about 2 cm less [URL="http://www.rxlist.com/script/main/art.asp?articlekey=33651"][U][COLOR=#0000ff]growth in height[/COLOR][/U][/URL] and 2.7 kg less growth in weight over 3 years), without evidence of growth rebound during this period of development. Published data are inadequate to determine whether chronic use of amphetamines may cause a similar suppression of growth, however, it is anticipated that they likely have this effect as well. Therefore, growth should be monitored during treatment with stimulants, and patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted. [/QUOTE]
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