Adverse Effects of α-2 Adrenergic Agonists and Stimulants in Preschool-age Attention-deficit/Hyperactivity Disorder:
Irene M Loe1, Nathan J Blum2, Justine Shults2
1Department of Pediatrics, Stanford University, Stanford, CA.
Insights
Stimulant medications for ADHD caused more adverse effects than alpha-2 adrenergic agonists (A2A) in preschoolers. Daytime sleepiness and headaches were more common with A2A, while stimulants led to issues like moodiness and appetite loss.
Area of Science:
- Pediatric pharmacology
- Neurodevelopmental disorders
- Adverse event monitoring
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is common in preschool-aged children.
- Pharmacological treatments, including alpha-2 adrenergic agonists (A2A) and stimulants, are used for preschool ADHD.
- Understanding the adverse effect (AE) profiles of these medications is crucial for safe and effective treatment.
Purpose of the Study:
- To compare the types and frequency of adverse effects (AEs) associated with A2A and stimulant medications in preschool-aged children with ADHD.
- To evaluate how age influences common AEs in this population.
Main Methods:
- Retrospective electronic medical record review of 497 children under 72 months of age.
- Data collected from 7 US academic medical centers.
- Analysis of AEs for children treated with A2A or stimulants between 2013 and 2017.
Main Results:
- Distinct AE profiles were observed for A2A and stimulants.
- A2A were associated with more daytime sleepiness and headaches.
- Stimulants showed higher rates of moodiness, sleep difficulties, appetite suppression, stomachaches, skin picking, withdrawn behavior, and weight loss. Younger age correlated with disruptive behavior and sleep issues.
Conclusions:
- Stimulants generally had a higher rate of AEs compared to A2A.
- AE profiles, alongside efficacy, should guide clinical decisions for preschool ADHD treatment.
- Further randomized clinical trials are necessary to comprehensively compare A2A and stimulant efficacy and safety.
Objectives:
To characterize and compare the type and frequency of a range of common and uncommon adverse effects (AEs) associated with α-2 adrenergic agonist (A2A) and stimulant treatment of attention-deficit/hyperactivity disorder at preschool-age as well as to evaluate the impact of age on common AEs.
Study Design:
This was a retrospective electronic medical record review of children <72 months of age (n = 497) evaluated at outpatient developmental-behavioral pediatric practices at 7 US academic medical centers within the Developmental-Behavioral Pediatrics Research Network. Data on AEs were abstracted for children who had treatment initiated by a developmental-behavioral pediatrician with an A2A or stimulant medication between January 2013 and July 2017; follow-up was complete by February 2019.
Results:
A2A and stimulants had distinctive AE profiles. A2A compared with stimulants had a greater proportion with daytime sleepiness and headaches; stimulants had significantly greater proportions for most other AE, including moodiness/irritability, difficulty with sleep, appetite suppression, stomachaches, skin picking/repetitive behaviors, withdrawn behavior, and weight loss. Younger age was associated with disruptive behavior and difficulty with sleep.
Conclusions:
Stimulants had a greater rate of most AEs compared with A2A. AE profiles, together with efficacy, should inform clinical decision-making. Prospective randomized clinical trials are needed to fully compare efficacy and AE profiles of A2A and stimulants.
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