Dikkat Eksikliği ve Hiperaktivite Bozukluğu Olan Çocuklarda Kullanılan Uzun Etkili Metilfenidat Bileşiklerinin ve Atomoksetinin Kardiyak Fonksiyonlar Üzerindeki Etkileri

Amaç: Dikkat Eksikliği ve Hiperaktivite Bozukluğunun (DEHB) tedavisinde metilfenidat (MPH) ve atomoksetin (ATX) en yaygın olarak reçete edilen ilaçlardır. Yaygın kullanılmalarına rağmen, kardiyovasküler güvenilirlikleri hakkında endişeler vardır. Bu çalışmada DEHB ilaçlarının kardiyak fonksiyonlar üzerine etkilerini araştırmayı amaçladık. Yöntem: Hasta gruplarına 46 ozmotik-salınımlı oral sistem metilfenidat (OROS-MPH) kullanan hasta, 46 geç-salınımlı metilfenidat (ER-MPH) kullanan hasta ve en az altı aydır ATX kullanan 46 DEHB tanılı çocuk dahil edildi. Normal kardiyak bulguları olan 46 çocuk kontrol grubu olarak alındı. Tüm katılımcılar sosyodemografik bilgi formu, fizik muayene, 12 kanallı elektrokardiyografi (EKG), transtorasik 2D ekokardiyografi, Doppler ekokardiyografi ve doku Doppler görüntüleme (TDI) kullanılarak değerlendirildi. Bulgular: Gruplar arasında A dalga hızı, E/A ve E' septal parametrelerinde istatistiksel olarak anlamlı fark izlendi (p=0,002, p<0,001, p=0,002, sırasıyla). ATX kullanan çocuklarda, OROS-MPH kullananlara ve kontrollere göre daha yüksek A dalga hızı (p<0,001, p=0,007, sırasıyla) ve OROS-MPH kullananlara ve kontrollere göre daha düşük E/A (p<0,001, her ikisi için) saptandı. ER-MPH ve ATX kullanan çocukların E' septal değerleri kontrol grubuna göre daha düşüktü (p<0,001, p=0,002, sırasıyla). Kalp hızı ATX kullananlarda kontrol grubuna göre daha yüksekti (p=0,002). ER-MPH ve ATX grubunda sistolik kan basıncı kontrol grubuna göre daha düşüktü (p= 0,001). Sonuç: ATX tedavisi, uzun etkili MPH ilaçlarından daha fazla miyokardiyal relaksasyonda bozulmaya sebep olmuştur. ER-MPH tedavisi, kardiyak diyastolik fonksiyonlar üzerinde OROS-MPH'ye göre daha fazla negatif etki yaratmıştır. Sonuç olarak, DEHB ilaçları kardiyak fonksiyonlar üzerinde olumsuz etkiler yaratabilir.

Anahtar Kelimeler:

metilfenidat, atomoksetin, doku Doppler görüntüleme, dikkat eksikliği ve hiperaktivite bozukluğu

Effects of Long-Acting Methylphenidate Formulations and Atomoxetine on Cardiac Functions in Children with Attention Deficit And Hyperactivity Disorder

Objectives: Methylphenidate (MPH) and Atomoxetine (ATX) are most commonly prescribed for the treatment of Attention Deficit And Hyperactivity Disorder (ADHD). Despite their widespread use, there are concerns about their cardiovascular safety. In this study, we aimed to investigate the effects of ADHD medications on cardiac functions. Methods: Forty-six children with ADHD disorder using osmotic-release oral system methylphenidate (OROS-MPH), 46 using extended-release methylphenidate (ER-MPH), and 46 using ATX for at least six months were included in the patient groups. 46 children with normal cardiac findings were included as the control group. All participants were evaluated using a sociodemographic information form, physical examination, 12-channel electrocardiography (ECG), transthoracic 2D echocardiography, Doppler echocardiography, and tissue Doppler imaging (TDI). Results: Statistically significant differences were observed in terms of A wave velocity (p=0,002), E/A (p<0,001), and E’ septal (p=0,002) between the groups. Children using ATX had higher A wave velocity than OROS-MPH users and controls (p<0.001, p=0.007, respectively) and lower E/A than OROS-MPH users and controls (p<0.001, for both). Children using ER-MPH and ATX had lower E’ septal values compared to the control group (p<0.001, p=0.002, respectively). Heart rate is higher in ATX users than in the control group (p=0,002). Systolic blood pressure was lower in the ER-MPH and ATX group compared to the control group (p=0.001, for both). Conclusion: ATX medication exhibited impaired myocardial relaxation findings more than long acting-MPH medications. ER-MPH medication stated negative findings in diastolic cardiac functions more than OROS-MPH. As a result ADHD medications can produce negative effects on cardiac functions.

Keywords:

methyphenidate, atomoxetine, tissue Doppler imaging, attention deficit and hyperactivity disorder,

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