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Area of Science:

  • Pharmacology
  • Neurology
  • Vascular Medicine

Background:

  • Raynaud syndrome (RS) is a vasculopathy causing impaired blood flow to extremities, presenting as skin discoloration and cold sensitivity.
  • RS can be primary or secondary to various factors, including medications.
  • Previous reports suggest a potential association between ADHD medications and RS, necessitating a literature review.

Purpose of the Study:

  • To systematically review the published literature on Raynaud syndrome associated with medications used to treat attention-deficit/hyperactivity disorder (ADHD).

Main Methods:

  • A comprehensive search of PubMed and Embase was conducted for English articles detailing RS cases in patients on ADHD medications.
  • Included medications were stimulants, atomoxetine, guanfacine, and clonidine.
  • The Naranjo Adverse Drug Reaction Scale was used to assess the probability of a causal relationship.

Main Results:

  • The review identified 61 cases of RS linked to ADHD medications, primarily methylphenidate and (dex)amfetamine, and less commonly atomoxetine.
  • Most cases were mild and resolved upon medication adjustment.
  • The Naranjo criteria indicated a 'possible' to 'definite' causal role for ADHD medication in 28 assessed cases, with some severe outcomes like ulceration and amputation reported.

Conclusions:

  • A definitive causal relationship between ADHD medications and RS cannot be established due to the observational nature of the studies.
  • Routine monitoring for RS signs is recommended for patients on CNS stimulants or atomoxetine, particularly during treatment initiation or dose changes.
  • Further large-scale, controlled studies are needed to clarify the association and control for confounding factors.