Cardiovascular Safety of Atomoxetine and Methylphenidate in Patients With Attention-Deficit/Hyperactivity Disorder in Japan: A Self-Controlled Case Series Study

Author:

Zheng Yunlong1ORCID,Fukasawa Toshiki12ORCID,Yamaguchi Fumitaka1,Takeuchi Masato1,Kawakami Koji1ORCID

Affiliation:

1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Japan

2. Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Japan

Abstract

Objective: To investigate the association between atomoxetine or methylphenidate use and arrhythmia, heart failure (HF), stroke, and myocardial infarction (MI) in attention-deficit/hyperactivity disorder (ADHD) patients mainly focused on the people of working age. Methods: In a self-controlled case series study using a Japanese claims database, we identified events of arrhythmia, HF, stroke, and MI among 15,472 atomoxetine new users and 12,059 methylphenidate new users. Adjusted incidence rate ratios (aIRRs) of outcome events were estimated using multivariable conditional Poisson regression. Results: An increased risk of arrhythmia was observed during the first 7 days after the initial atomoxetine exposure (aIRR 6.22, 95% CI [1.90, 20.35]) and in the subsequent exposure (3.23, [1.58, 6.64]). No association was found between methylphenidate exposure and arrhythmia, nor between atomoxetine or methylphenidate exposure and HF. The limited number of stroke and MI cases prevented thorough analysis. Conclusions: Clinicians should consider monitoring for arrhythmia after patients initiating or re-initiating atomoxetine.

Publisher

SAGE Publications

Subject

Clinical Psychology,Developmental and Educational Psychology

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