The Association Between Stimulant Medication Use and Mortality.

Area of Science:

• Pharmacovigilance and Pharmacoepidemiology
• Cardiovascular Safety of Medications
• Public Health Research

Background:

• Prescription stimulants are widely used for conditions like ADHD.
• Concerns exist regarding the cardiovascular safety of these medications.
• Large-scale data analysis is needed to evaluate mortality risks.

Purpose of the Study:

• To investigate the association between prescription stimulant use and mortality.
• To analyze data from the FDA Adverse Event Reporting System (FAERS) and electronic health records (EHR).
• To assess risks in adult patients at a large metropolitan health care center.

Main Methods:

• Two analyses were conducted: FAERS data and EHR data using a self-controlled case series (SCCS) method.
• FAERS analysis compared sudden death events with stimulants versus control medications using propensity score matching.
• SCCS analysis assessed all-cause mortality risk following stimulant initiation within individuals.

Main Results:

• Stimulants (dextroamphetamine, methylphenidate, and the stimulant class) were significantly associated with sudden death in FAERS analyses.
• These stimulants were also significantly associated with all-cause mortality in SCCS analyses.
• Mortality risk increased with age at first stimulant use for most stimulants.

Conclusions:

• A significant association between stimulant use and mortality was documented.
• Existing guidance to assess cardiovascular disease and risk factors before prescribing stimulants is reinforced.
• Particular caution is advised for older adults initiating stimulant therapy.