Mehmet Birhan YILMAZ, Hakan GÜNEŞ, Hakkı KAYA, Recep KURT, Osman BETON

Acute myocarditis induced by dosage increment of methylphenidate in an adolescent patient

Dikkat eksikliği-hiperaktivite bozukluğu (DEHB), çocuk ve gençlerde en çok karşılaşılan psikiyatrik hastalıklardan biridir. DEHB tanısı ve tedavisi bu günlerde giderek artmaktadır. Metilfenidat, sinapslardaki dopamin ve norepinefrin düzeylerini arttırarak etkisini gösteren, güçlü bir psikostimulan ajandır. Çocuk ve gençlerde DEHB tedavisinde yaygın olarak kullanılan bir ilaçtır. İyice anlaşılmamış olmasına rağmen, DEHB tedavisi ve kardiyomiyopati gelişimi arasında nedensel bir ilişki öne sürülmüştür. Fakat bu nedensel ilişki, anti-DEHB ilaçlarına bağlı kardiyomyopati gelişen hastalarda, anti-DEHB ilaçların kesildikten sonra kalp fonksiyonu ve fonksiyonel sınıfın düzelmesi veya normale dönmesi ile desteklenmektedir. Bu olgu sunumunda, metilfenidat doz artışına bağlı akut miyokardit gelişen 14 yaşında bir erkek hastayı betimledik. Hasta, medilfenidat kesilmesinden sonra tamamen düzeldi. Metilfenidat tedavisi alan hastaların kardiyovasküler yönden izlenmesi, psikiyatristler, pratisyen hekimler ve kardiyologlar için önemli bir görev olmalıdır.

Genç erişkin hastada metilfenidat doz artışına bağlı gelişen akut miyokardit

Attention deficit-hyperactivity disorder (ADHD) is one of the most common psychiatric disorders seen in children and adolescents. ADHD is increasingly diagnosed and treated nowadays. Methylphenidate is a potent psychostimulant that exerts its effects by increasing dopamine and norepinephrine levels in synapses. It is a widely used medication for treatment of ADHD in children and adolescents. Although not well-established, a causal relationship between treatment of ADHD and development of cardiomyopathy has been suggested. However, this suggestion was supported by the normalization or improvement in cardiac function and functional class after cessation of anti-ADHD medications in patients suffering from cardiomyopathy related to antiADHD medications. In this case report, we describe a case of 14-year-old male patient who developed acute myocarditis due to the dose increment of methylphenidate. The patient completely recovered after discontinuation of methylphenidate. Cardiovascular monitoring of patients on methylphenidate treatment should be an important task for psychiatrists, general practitioners and cardiologists.

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