Medication Use ADD ADHD and Risk of Motor Vehicle Crashes

 Is there a relationship between medication use and a LOWER risk of accidents? 

Yes. 

Short term? Yes.

Long-term? Yes.

Men? Yes.

Women? Yes. 

Please take your medicines. 

Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes

Question

Is the use of attention-deficit/hyperactivity disorder medication associated with a reduced risk of motor vehicle crashes in patients with the disorder?

Findings

In a national cohort study of 2 319 450 patients with attention-deficit/hyperactivity disorder, the use of medication for the disorder was associated with a significant reduction in the risk of motor vehicle crashes in male and female patients.

Meaning

Attention-deficit/hyperactivity disorder medication use may lower the risk of motor vehicle crashes, a prevalent and preventable cause of mortality and morbidity among patients with the disorder.

ADHD medication to help with binge eating

A study found that ADHD medication may be an effective treatment for binge eating disorders.

A drug approved for the treatment of attention deficit-hyperactivity disorder (ADHD), lisdexamfetamine dimesylate, cuts the number of binge eating days in people with binge eating disorder, according to a study published in JAMA Psychiatry^[1].

There is currently no approved medicine for binge-eating disorder, an eating disorder characterized by recurrent episodes of excessive food consumption, a sense of loss of control and psychological distress, and being overweight or obese.

Guidance from the UK’s National Institute for Health and Care Excellence, published in 2004, recommends that patients follow an evidenced-based self-help programme as a first step or a trial course of a selective serotonin reuptake inhibitor. Patients may also be offered a course of cognitive behavioural therapy (CBT), which has been shown to have an impact on binge eating behaviour, it says.

In this study, researchers from the Lindner Center of HOPE in Mason, Ohio, compared 11 weeks of treatment with 30mg/day, 50mg/day or 70mg/day lisdexamfetamine (marketed at Elvanse in Europe and as Vyvanse in the United States) with placebo in a randomised trial including 260 adults with moderate to severe binge-eating disorder.

The number of binge eating days per week decreased in the 50mg/day and 70 mg/day treatment groups compared with placebo – log-transformed binge eating days per week decreased with the 50-mg/day (least squares [LS] mean [SE] change, −1.49 [0.066]; P = .008) and 70-mg/d (LS mean [SE] change, −1.57 [0.067]; P < .001) but not in the 30 mg/day group (LS mean [SE] change, −1.24 [0.067]; P = .88).

Fewer patients also achieved four-week binge eating cessation in the placebo group (21.3%) compared with the 50 mg/day (42.2%) and 70 mg/day (50%) treatment groups.

Patients who took lisdexamfetamine also lost weight over the 11 weeks: the mean (SD) change in body weight was −3.1kg (3.64) for 30mg/day, −4.9kg (4.43) for 50mg/day, and −4.9kg (3.93) for 70mg/day (P < .001). The weight of patients in the placebo group remained unchanged at −0.1kg (3.09).

The authors say their findings support the need for further assessment of lisdexamfetamine as a treatment option for decreasing binge eating behaviour in adults with moderate to severe binge-eating disorder. “Confirmation of these findings in ongoing clinical trials may result in improved pharmacologic treatment for moderate to severe binge-eating disorder,” they say.

“Increased efficacy with increasing dosages of lisdexamfetamine suggests a dose-response relationship” was involved, they add, and “the lisdexamfetamine safety profile was generally consistent with findings in adults with ADHD”.

Susan Ringwood, chief executive officer of Beat, the charity that supports and campaigns on behalf of people with eating disorders, says: “We know how important it is for people to get evidence-based psychological treatment for their eating disorder, and that pharmacological treatment is not sufficient by itself. This study seems to be saying that because it isn’t easy to access CBT and other evidence-based psychological treatments, these drugs are an alternative.”

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Pharmacists help reduce errors in anti-epileptic drug prescriptions

Pharmacists can help reduce errors in anti-epileptic drug prescriptions.

Clinical pharmacists can reduce anti-epileptic drug (AED) prescription errors that commonly result from incomplete or poor documentation, according to a literature review published in Seizure, The European Journal of Epilepsy. 

Researchers from the Alder Hey Children’s NHS Foundation Trust in the United Kingdom conducted a 12-month retrospective review of all pediatric outpatient prescriptions of anti-epileptic drugs (AEDs) at a large children’s hospital. In the study, the authors acknowledged that pediatric AEDs are particularly difficult to prescribe, given the wide variety of available choices and potential interactions among AEDs and other medications. 

The investigators monitored all new prescriptions for AEDs issued from the hospital’s general pediatric and pediatric neurology departments in 2012. Data was collected regarding patient demographics, diagnosis/indication for the AED, clarity of dosage instructions, prescriber details, and whether a pharmacist intervention was required prior to dispensing the medication. 

Over the course of the year, a total of 262 new AED prescriptions were written, with 19 patients receiving more than 1 AED prescription. Of those prescriptions, an astounding 72.1% were deemed incomplete with at least 1 piece of missing information, the study authors noted. 

Furthermore, 164 (62.6%) of the prescriptions did not document any diagnosis or reason for prescribing the AED. Of the remaining 98 prescriptions, 50 documented only the word “epilepsy,” while 48 described a non-epileptic diagnosis, such as “migraine,” “behavioral problems,” and “chronic pain.” 

AED prescribers recorded their designation and immediate contact details in just 41.6% of all AED prescriptions. Of those detailed prescriptions, 65.1% were written by a senior doctor, 17.4% were prescribed by a specialist trainee or junior doctor, and another 17.4% were illegible or not recorded. 

Among all epilepsy diagnoses, the most commonly prescribed AED was sodium valproate, followed by a tie between carbamezapine and levetiracetam. For prescriptions with a designated non-epileptic diagnosis, the most commonly prescribed medication was gabapentin. 

Pharmacists contacted physicians concerning 44 prescriptions (16.8%), 15 (34%) of which were due to errors in dosage or frequency of administration. Such dosing errors were identified by pharmacists for carbamazepine, gabapentin, lamotrigine, and topiramate, among other AEDs. According to the researchers, all AED prescriptions with dosing errors were amended prior to being dispensed. 

“Although there were high numbers of incomplete or inadequate prescriptions in the current study, no patients had their medication incorrectly dispensed, (which) reflects the pharmacists’ review of each prescription prior to the drug being dispensed,” the study authors concluded. “Clearly, it is the clinician’s responsibility to prescribe the most appropriate AED, but it might be reasonable to have the choice of drug confirmed by a clinical pharmacist.”

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Study: ADHD Medications will not stunt children's growth

A study shows that taking ADHD medications will not stunt a child's growth.

Stimulant medications -- such as Adderall, Ritalin and Concerta -- used to treat attention-deficit/hyperactivity disorder (ADHD) in children, won't stunt their growth, a new study suggests.

"Stimulant medication did not affect children's final height as adults," said study researcher Dr. Slavica Katusic, an associate professor of pediatrics at the Mayo Clinic in Rochester, Minn.

Katusic noted that results of earlier studies have been mixed, with some showing these drugs retard growth and others showing they don't. But, most of the previous studies had limitations, such as having too few children or spotty information about adult height, she said.

Katusic said this study is unique because it followed a group of people with ADHD who were taking stimulant medications and compared them with a group with ADHD who were not taking medication and also a group that didn't have ADHD. These individuals were followed from childhood to adulthood, she said.

ADHD is one of the most common disorders of childhood, according to the U.S. National Institute of Mental Health (NIMH). Symptoms include difficulty paying attention or staying focused on one task, overactivity and impulsive behavior, the NIMH explains.

Stimulant medications are a mainstay of ADHD treatment, and while it may seem odd to use stimulant medication on an overactive child, stimulant drugs have a calming, focusing effect on youngsters with ADHD, according to the NIMH. Katusic said these drugs are important for improving school and social functioning.

Katusic's team studied 340 children with ADHD and 680 without the condition. "We compared the height when they were children and when they were grown up," she said.

The average follow-up time was 26 years for those with ADHD and 23 years for people without ADHD. Approximately 70 percent of those with ADHD who completed the study had taken stimulant medication for more than three months, the researchers noted.

There was no difference in adult height between those who took ADHD drugs and those who didn't, the investigators found.

"Neither childhood ADHD itself nor stimulant medication was associated with shorter stature as adults," Katusic said.

Boys with ADHD who were treated with stimulants for three or more months had a later growth spurt than boys who didn't take these drugs, but there was no difference in the size of the growth spurt, the researchers noted.

In addition, no connection was seen between the amount of time a child took stimulant drugs and adult height, the study authors found.

"But despite our findings, doctors should monitor growth when making medication decisions," she said. "Our study says don't worry at all, but human beings are all different and you always have to be careful."

The report was published online Sept. 1 in the journal Pediatrics.

Dr. Marcel Deray, a pediatric neurologist at Miami Children's Hospital, said, "This is good news, because we discuss this issue with parents of kids with ADHD."

Deray hopes the study will be replicated to prove the point that these stimulants don't affect height. "It would good to have a couple of studies showing the same thing," he said.

He also said this finding should be reassuring to parents who may be reluctant to allow their children to use these drugs because of the potential risk of stunting their child's growth.

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Medications for shift workers show little effectiveness

A review of medications shift workers take both for alertness and to help them sleep have little effectiveness.

Shift workers are taking drugs to help them stay awake or get to sleep despite weak evidence for their benefit, according to a new Cochrane review. The authors of the review found only small numbers of trials testing over-the-counter and prescription drugs used by shift workers, and the results suggest that for some people they might do more harm than good.

In most developed countries, at least 10% of the workforce is involved in some form of shift work. European statistics suggest that as many as three quarters of the population have 'non-standard' working hours. Disturbances to normal sleeping and waking patterns increase the risk of accidents and affect shift workers' health. It is therefore important to avoid shift work where possible and improve shift work schedules to help shift workers achieve more normal sleeping and waking patterns. In jobs where shift work cannot be avoided, such as health care, the police force or the military, drugs can potentially offer short-term benefits.

The review included 15 trials involving a total of 718 people. In nine trials, the over-the- counter hormone drug melatonin helped shift workers sleep for around 24 minutes longer during the night or day, compared to placebos. However, it did not help them get to sleep any quicker. Data from only one trial of the hypnotic drug zoplicone was available. The drug was no more effective than placebos for helping shift workers sleep during the day.

The remaining trials focused on caffeine and two drugs, modafinil and armodafinil, that are prescribed for sleepiness during night shifts. In one trial, caffeine reduced sleepiness during night shifts, when workers also napped before shifts. Modafinil and armodafinil, used by shift workers in one and two trials respectively, increased alertness and reduced sleepiness. However, they also caused headaches, nausea and a rise in blood pressure in a substantial number of people. Due to the limited benefits and frequent side effects, neither of these drugs is approved for shift workers in Europe.

"For lots of people who do shift work, it would be really useful if they could take a pill that would help them go to sleep or stay awake at the right time," said lead author of the review, Juha Liira, who is based at the Finnish Institute of Occupational Health in Helsinki, Finland. "But from what we have seen in our review, there isn't good evidence that these drugs can be considered for more than temporary use and some may have quite serious side effects."

Most of the data reported in the review was from small, low quality trials. In addition, trials tended to be carried out in specific settings, such as health care or oil rigs, so their results may be less relevant for workers in other types of roles.

"It's curious that there's such a clear gap in the research," said Liira. "It may well be that studying the effects of these drugs or others drugs in properly designed trials would be seen as unethical because workers should not need drugs to get along with their work. So the studies just haven't been done or if they have, our review has not been able to identify relevant data."

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