8, British Journal of Clinical Pharmacology, Vol. Moreover, the death-to-survey interval was not significantly related to reports of stimulant exposure among sudden unexplained death cases (odds ratio=0.99, 95% CI=0.98–1.01; p=0.46). 3, Progress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. Br J Haematol 2003; 123:359–365Google Scholar, 23. 24, No. 26, No. 6, Pediatric Neurology Briefs, Vol. A comprehensive series of sensitivity analyses yielded qualitatively similar findings. The present article provides empirical data on the risk of sudden death and stimulant drug use in children and adolescents. Conclusions: This case-control study provides support for an association between the use of stimulants and sudden unexplained death among children and adolescents. 4, Zeitschrift für Gerontologie und Geriatrie, Vol. However, the focus of sensitivity analysis is on the effect sizes (the odds ratios), which reflect the strength of the association, rather than the p values, which are a function of sample size (31) . Ten of the 564 sudden unexplained death cases (1.8%) were identified as having used stimulants at the time of their deaths ( Table 3 ). 169, No. Chichester, UK, John Wiley & Sons, 2000Google Scholar, 31. 33, No. We're empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options. The Food and Drug Administration (FDA), using the Adverse Event Reporting System, reported 11 sudden deaths in pediatric patients taking methylphenidate from January 1992 to February 2005 (5) . His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. It is conceivable that, despite our rigorous efforts to exclude or adjust for potential confounding factors, some unmeasured factors other than stimulant use were responsible for the observed association. Some are far more susceptible to drug side effects than others. The distribution of the information sources available for the 564 matched pairs was as follows: informant reports only (29.6%); medical examiner records or toxicology reports only (55.5%); informant reports and medical examiner records but no toxicology report (5.3%); and all three sources (9.6%). Wolraich ML, Doffing MA: Pharmacokinetic considerations in the treatment of attention-deficit hyperactivity disorder with methylphenidate. 21, No. For example, although gross structural cardiac disease was presumably excluded by autopsy, autopsy data were not available for two sudden unexplained death cases with stimulant exposure, and forensic pathology varies substantially in its ability to identify physiological as opposed to anatomic cardiovascular disease. We estimated the association between sudden unexplained death and stimulant exposure using a logistic regression model that predicted sudden unexplained death from stimulant exposure. 26, No. Three individuals receiving stimulants were excluded from our group of sudden unexplained death cases because of notations of cardiac hypertrophy in their autopsies, even though the cardiac abnormalities were not cited as the cause of death. 8, Journal of the American Academy of Child & Adolescent Psychiatry, Vol. 4, Children and Youth Services Review, Vol. However, treatment is available. 33, No. 10, Pharmacoepidemiology and Drug Safety, Vol. 85, No. 39, No. Neumaerker KJ: Mortality and sudden death in anorexia nervosa. 2, 8 July 2010 | Expert Opinion on Drug Safety, Vol. Each matched pair was unique; an individual motor vehicle accident victim was matched to one and only one case of sudden unexplained death. Less serious cardiovascular effects have also been reported in association with stimulant medications. To locate informants, various Internet search engine white pages, a credit bureau database (without access to credit information), ChoicePoint (CDB Infotek), and PrivateEye were used. 3, 14 February 2015 | pädiatrie: Kinder- und Jugendmedizin hautnah, Vol. Some people are ultra-rapid metabolizers, which means they quickly transform codeine into morphine, which in turn can lead to overdose. 31, No. 32, No. Lancet 1988; 1:584–585Google Scholar, 2. Pharmacotherapy 2008; 28:1408–1412Google Scholar, 5. There have been reports of pediatric stroke after long-term use of methylphenidate within therapeutic ranges (1) . 69, No. Physiological abnormalities that confer risk (e.g., cardiac depolarization and repolarization abnormalities such as Brugada syndrome and long QT syndrome) could not be reliably excluded from the analysis. 76, No. 1, No. Arch Pediatr Adolesc Med 2003; 157:17–25Google Scholar, 30. A significant association of stimulant use with sudden unexplained death emerged from the primary analysis, which was based on exact conditional logistic regression (odds ratio=7.4, 95% CI=1.4 to 74.9). It would normally persist for a couple of hours, gradually tapering off. 23, No. 50, No. Data collection, from March 1997 to January 2008, involved the following phases. Address correspondence and reprint requests to Dr. Gould, Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY 10032; [email protected] (e-mail). Gothelf D, Gruber R, Presburger G, Dotan I, Brand-Gothelf A, Burg M, Inbar D, Steinberg T, Frisch A, Apter A, Weizman A: Methylphenidate treatment for attention-deficit/hyperactivity disorder in children and adolescents with velocardiofacial syndrome: an open-label study. Matthews JN, Altman DG: Interaction 2: compare effect sizes not p values (statistics notes). Zito JM, Safer DJ, DosReis S, Gardner JF, Magder L, Soeken K, Boles M, Lynch F, Riddle MA: Psychotropic practice patterns for youth: a 10-year perspective. 51, No. 12, No. 25, No. The study also has important limitations. Second, multiple sources of information were used to increase the sensitivity of detecting stimulant use. 39, No. She prescribes medications with names I don’t recognize and I react badly to them. Although included subjects are not representative of all sudden unexplained death cases, pairs were either matched (age, gender, and date of death) or adjusted (race and region of death) for these sociodemographic and vital characteristics. 3, 20 March 2012 | Criminal Justice and Behavior, Vol. Fourth, toxicological assays were not conducted consistently across jurisdictions and may not have been sufficiently sensitive to detect therapeutic levels of methylphenidate, yielding an unreliable measure of exposure. Thus, while we are confident that the toxicology screens accurately ruled out overdoses, they may have been insensitive in some cases to therapeutic levels of methylphenidate. Each sensitivity analysis used the subsample of dyads with observed data for the specific information source. Neurology 2001; 57:430–434Google Scholar, 22. 6 September 2016 Categories: , Articles Female sexual dysfunction affects approximately 40 million women in America. 2, 30 January 2020 | Pharmacoepidemiology and Drug Safety, Vol. 58, No. 54, No. The sensitivity analyses, excluding the stimulant-exposed sudden death case with concomitant tricyclic antidepressants, yielded essentially the same results, with the smallest odds ratio being 3.2, again for the scenario “any stimulant, limited to medical examiner/toxicology reports.” The use of clonidine appeared not to be associated with sudden death, providing no justification to delete the case with concomitant clonidine and stimulants. 10, 1 September 2009 | American Journal of Psychiatry, Vol. CNS Drugs 2004; 18:243–250Google Scholar, 40. 9, No. In light of concerns over the safety of stimulant medications, the FDA in 2006 requested an expansion of the inquiry of stimulants to include amphetamine, dextroamphetamine, and methamphetamine. J Am Acad Child Adolesc Psychiatry 2008; 47:977–980Google Scholar, 9. May be there be thousands of us along, marching in Armies along with Anonymous to bring in the ultimate state of Freedom. Just to illustrate, children’s cough medicine with codeine put me in the emergency room with a drug overdose. 2, European Child & Adolescent Psychiatry, Vol. 3, International Journal of Psychiatry in Clinical Practice, Vol. In light of matching on sources of information (e.g., medical examiner records, toxicology, and informant reports), only sources available for both members of the matched pair were used to define exposure status. Clin Pharmacol Ther 1999; 66:295–305Google Scholar, 17. Detailed information on the dose or duration of stimulant use was not available. Results: In 10 (1.8%) of the sudden unexplained deaths it was determined that the youths were taking stimulants, specifically methylphenidate; in contrast, use of stimulants was found in only two subjects in the motor vehicle accident comparison group (0.4%), with only one involving methylphenidate use. Take caffeine, for example. 4, 4 October 2012 | Pediatric Cardiology, Vol. Indiana, Kansas, Maryland, Wisconsin, and Wyoming were excluded because their state statutes did not allow direct interviewing of families of deceased individuals or had restrictive contact requirements. 16, No. contributing factors in stimulant dependence, reasons for over sensitivity to stimulants. 6, Journal of Child Psychology and Psychiatry, Vol. 1, 23 August 2019 | Forensic Science, Medicine and Pathology, Vol. 3, International Clinical Psychopharmacology, Vol. 18, No. 3, International Journal of Early Childhood, Vol. 27, No. 23, No. Are you taking ST.JOHN'S WORT supplements or any herbal preparations with reuptake or MAO-inhibiting properties? This may have yielded an underestimation of the association between sudden death and stimulant use. Attention Deficit Hyperactivity Disorder Screening Electrocardiograms: A Community-Based Perspective, Trouble de l’hyperactivité avec déficit de l’attention, Sudden Unexplained Cardiac Arrest in Apparently Healthy Children: A Single-Center Experience, Prediction and prevention of sudden death in young populations: the role of ECG screening, Adolescent Attention Deficit Hyperactivity Disorder in the Secure Treatment Setting, Blood Pressure and Heart Rate Over 10 Years in the Multimodal Treatment Study of Children With ADHD, Methylphenidate and Risk of Serious Cardiovascular Events in Adults, Cautious Reassurance: Cardiovascular Risk in the Context of Stimulant Use, Psychiatric Aspects of Sudden Cardiac Arrest and Implantable Cardioverter-Defibrillators, Behavioral Problems in Children and Adolescents, Cardiovascular Events and Stimulants for ADHD, Central nervous system stimulants and drugs that suppress appetite, Evaluating Dopamine Reward Pathway in ADHD: Clinical Implications, Assessment and Treatment of ADHD in Adults, Safety of stimulant treatment in attention deficit hyperactivity disorder: part II, Le trouble déficitaire de l’attention avec hyperactivité : données récentes des neurosciences et de l’expérience nord-américaine, The Food and Drug Administration's Drug Safety Oversight Board: An Evolving Paradigm for Clinical Input on Drug Safety Topics, Pre-existing cardiovascular conditions and pharmacological treatment of adult ADHD, Increased Risk of Sudden Death Among Youths and Stimulant Use: Determining Alternate Potential Factors.