Older adults prescribed stimulant medications appear to be at an elevated risk of cardiovascular problems in the first 30 days after beginning the treatment, according to a study published today in JAMA Network Open. However, these risks decrease over time, with no evidence of increased cardiovascular risk at six months and one year after initiating treatment.
“Although stimulants are most commonly used among children and youth for the treatment of attention-deficit/hyperactivity disorder (ADHD), an increase in stimulant use among older adults in recent years has been observed,” wrote Mina Tadrous, PharmD., Ph.D., of the University of Toronto and colleagues. Doctors may prescribe stimulants off label to older adults for the treatment of depression, poststroke recovery, motor function, and fatigue, they noted. There is evidence that stimulants can increase resting heart rate and systolic blood pressure, but few studies have examined the cardiovascular impact of stimulants in older adults.
Tadrous and colleagues used hospital and prescription databases to assess the cardiovascular outcomes of 6,457 Ontario residents aged 66 years and older who received a new prescription for a stimulant (for example, amphetamine, methylphenidate, lisdexamfetamine, or dextroamphetamine) between January 1, 2002, and March 31, 2015. These adults were matched with a control group of 24,853 similarly aged adults who did not take any stimulants during this time. Adults in both groups were followed for up to 365 days or until they experienced a cardiovascular event (myocardial infarction, stroke, transient ischemic attack, or ventricular arrhythmia), died, or stopped taking stimulants.
Compared with the control group, older adults who took stimulants had a 40% increased risk of any cardiovascular event 30 days after starting their prescription. Among individual outcomes, stimulant use was not associated with any heart attack risk but was associated with a 60% increased risk of stroke/transient ischemic attack and a 300% increased risk of ventricular arrhythmia. Adults who took stimulants did not experience any increased cardiovascular risk compared with controls at 180 or 365 days after starting medication, except for continued arrhythmia risk at 180 days.
“These findings suggest that safety considerations should be included when stimulants are prescribed to older adults,” the authors concluded.
To read more on this topic, see the Psychiatric News article “To Improve Safety in Older Patients, Consider Deprescribing.”
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