A cardiopulmonary study of lisdexamfetamine in adults with attention-deficit/hyperactivity disorder

Abstract

Objectives. Due to concerns about the safety of stimulants for ADHD, novel assessments of the cardiopulmonary impact of these agents are needed. Methods. An open design of lisdexamfetamine (LDX) in 15 adults with DSM-IV ADHD. Following a psychiatric evaluation and medical history, subjects underwent echocardiography (TTE) and cardiopulmonary exercise testing (CPET). LDX was titrated to 70 mg daily over 6 weeks, followed by monthly visits to 6 months. Change in TTE and CPET measures were examined following up to 6 months of LDX. Results. At endpoint, there were no significant alterations in indices of cardiac systolic performance, or in metabolic and ventilatory variables at maximum exertion (P values >0.05). We found significant mean changes in resting LV systolic dimension and Doppler diastolic indices. Change in heart rate recovery at 1 min met statistical significance (P = 0.05). Conclusions. We did not detect clinically meaningful changes in cardiac structure and function or in metabolic and ventilatory variables at maximum exertion in ADHD adults receiving open LDX. The clinical significance of changes in resting LV dimension and indices of diastolic function are not in the direction of cardiomyopathy. Future large sample controlled study can examine these findings, as well as stimulants’ impact on heart rate recovery.

Key words::

• Cardiac
• cardiopulmonary
• lisdexamfetamine
• ADHD
• stimulant

Acknowledgements

MaryKate Martelon, Statistician, Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston.

Statement of Interest

Source of Funding: Investigator Initiated Study funded by Shire Pharmaceutical (P. Hammerness, PI). Dr. Hammerness: in the past 12 months, Dr Hammerness has participated in CME activities/writing supported by Shire Pharmaceuticals. Dr Hammerness has participated, as an investigator/principal investigator, in research studies funded by the following companies: Cephalon, Forest, GlaxoSmithKline, Johnson & Johnson, McNeil, Novartis, Ortho-McNeil Janssen, Shire, Takeda Pharmaceuticals and Elminda Ltd. Dr Hammerness has also received honoraria from commercial entities supporting the MGH Psychiatry Academy, www.mghcme.org. Dr Zusman: no disclosures related to this project. Dr Systrom: No disclosures related to this project. Dr Surman has received research support from the following: Abbott, Alza, Cephalon, Eli Lilly, the Hilda and Preston Davis Foundation, McNeil, Merck, New River, Nordic Naturals, Organon, Pfizer, Shire, and Takeda; has been a speaker for Janssen-Ortho, McNeil, Novartis, and Shire; and has been a consultant/advisor to McNeil, Shire, Somaxon and Takeda. Dr Baggish, Ms Schillinger and Ms Shelley-Abrahamson: no disclosures related to this project. Dr Wilens receives or has received grant support from: Abbott, McNeil, Lilly, Merck, and Shire Pharma. Dr Wilens has been a speaker for the following companies: Lilly, McNeil, Novartis, Shire Pharma. Dr Wilens is or has been a consultant for: Abbott, Astra-Zeneca, Euthymics, McNeil, Lilly, NIH, Novartis, Merck, Shire Pharma. Dr Wilens has a published book with Guilford Press.