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Growth perturbations from stimulant medications and inhaled corticosteroids
Erin Richardson1, Tasa Seibert1, Naveen K Uli1
1Division of Pediatric Endocrinology & Diabetes, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
Insights
Stimulant medications for ADHD and inhaled corticosteroids for asthma may cause temporary growth reduction in children. However, studies show minimal long-term impact on adult height, with benefits outweighing risks.
Area of Science:
- Pediatric pharmacology
- Growth and development
- Adverse drug effects
Background:
- Stimulant medications for ADHD and inhaled corticosteroids (ICS) for asthma are common in pediatrics.
- Growth attenuation is a known potential adverse effect of these medications.
Purpose of the Study:
- To review the impact of stimulant medications and ICS on pediatric growth.
- To compare short-term and long-term effects on height.
Main Methods:
- Review of existing literature on stimulant and ICS effects on growth.
- Analysis of short-term and long-term growth data from pediatric studies.
Main Results:
- Stimulants may cause short-term growth deficits (1-1.4 cm/year), with some studies showing minimal adult height loss, while others report up to 4.7 cm deficit with consistent use.
- ICS can cause mild short-term growth suppression (0.4-1.5 cm/year), with adult height impact generally not clinically significant (≤1.2 cm).
- Individual variability in growth suppression exists for ICS, influenced by factors like dose, age, and adherence.
Conclusions:
- The therapeutic benefits of stimulants for ADHD and ICS for asthma outweigh the potential risks of growth suppression.
- Strategies to minimize growth attenuation include using the lowest effective dose and regular monitoring.
- Vigilance is needed for combined medication use and potential adrenal insufficiency with ICS.
Abstract:
Stimulant medications for the treatment of attention deficit hyperactivity disorder (ADHD) and inhaled corticosteroids (ICS) for the treatment of asthma are two classes of medications that are commonly prescribed in pediatrics. Among other adverse effects of these medications, growth attenuation has long been a focus of investigation. With stimulants, growth deficits of 1-1.4 cm/year have been observed in the short term, mainly in the first 2 years of treatment, in a dose-dependent manner. Long-term studies on stimulants have reported divergent effects on growth, with many studies showing no clinically significant height deficits by adulthood. The study that followed the largest cohort of children on stimulants, however, reported an overall adult height deficit of 1.29 cm in subjects who had received stimulant medications, with mean adult height deficit of 4.7 cm among those taking the medication consistently. With ICS use, mild growth suppression is seen in the short term (particularly in the first year of therapy) with growth rates reduced by 0.4-1.5 cm/year. Available current evidence indicates that the impact of ICS use on adult height is not clinically significant, with effects limited to 1.2 cm or less. There is significant individual variability in growth suppression with ICS use, with the specific pharmacologic agent, formulation, dose exposure, age, puberty, medication adherence, and timing of administration being important modifying factors. Based on currently available evidence, the therapeutic benefits of ICS for management of asthma and stimulant medications for management of ADHD outweigh the potential risk for growth suppression. Strategies to minimize growth attenuation and other potential adverse effects of these medications include using the lowest efficacious dose, frequent assessments and dose titration. Particular vigilance is essential with concomitant use of multiple medications that can attenuate growth and to evaluate for potential adrenal insufficiency from ICS use.
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