From the Guidelines
For treating ADHD in patients with cardiovascular Ehlers-Danlos Syndrome (EDS), non-stimulant medications like atomoxetine (Strattera) at 40-100 mg daily or guanfacine (Intuniv) at 1-4 mg daily are generally preferred as first-line treatments due to their lower cardiovascular risk compared to stimulants, as supported by recent studies 1. When considering treatment options, it's essential to weigh the potential benefits and risks of each medication. Non-stimulant medications, such as atomoxetine and guanfacine, have been shown to be effective in treating ADHD with fewer cardiovascular side effects compared to stimulants 1. Key points to consider when treating ADHD in patients with cardiovascular EDS include:
- Non-stimulant medications are preferred due to their lower cardiovascular risk
- Atomoxetine and guanfacine are effective treatment options with a more favorable side effect profile
- Stimulants, such as methylphenidate, can be used at lower starting doses with gradual titration under close monitoring if necessary
- A thorough cardiovascular assessment, including ECG and blood pressure monitoring, is essential before initiating treatment
- Regular follow-up appointments to monitor vital signs and cardiac symptoms are crucial
- Behavioral therapy, organizational coaching, and lifestyle modifications should be incorporated as complementary non-pharmacological approaches As noted in a recent study 1, the risk of serious cardiovascular events is extremely low for both stimulants and non-stimulants, but clinicians should still obtain a personal and family cardiac history and perform additional evaluation if risk factors are present before starting any medication. In terms of specific medication side effects, atomoxetine has been associated with initial somnolence, gastrointestinal tract symptoms, and decreased appetite, while guanfacine and clonidine can cause somnolence, dry mouth, dizziness, and hypotension 1. Overall, a cautious and personalized approach to treating ADHD in patients with cardiovascular EDS is necessary, taking into account the specific cardiovascular manifestations present in each patient and collaborating with psychiatrists, cardiologists, and EDS specialists as needed.
From the Research
ADHD Treatment in Cardiovascular EDS
- There is limited research on the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in patients with cardiovascular Ehlers-Danlos Syndrome (EDS) 2, 3.
- Atomoxetine, a non-stimulant medication, has been shown to be effective in treating ADHD in children and adolescents 4, 5.
- However, its use in patients with cardiovascular EDS has not been specifically studied.
- Cardiovascular symptoms, such as lightheadedness and palpitations, are common in patients with hypermobile EDS, but structural cardiac abnormalities are uncommon 2, 3.
- The safety and efficacy of atomoxetine in patients with cardiovascular EDS are unknown, and more research is needed to determine its potential use in this population.
- Treatment algorithms involving the initial use of atomoxetine may be cost-effective in stimulant-naive, -failed, and -contraindicated children and adolescents with ADHD 4.
- Atomoxetine has been shown to be generally well-tolerated in children and adolescents with ADHD, with common adverse events including headache, abdominal pain, and decreased appetite 4, 5.
- However, its potential impact on cardiovascular symptoms in patients with EDS is unknown, and caution should be exercised when considering its use in this population 2, 3.