What are the long-term effects of stimulant medication?

From the Guidelines

Stimulant medications can have significant long-term effects, including potential cardiovascular issues, growth suppression in children, and psychological dependence, emphasizing the need for regular monitoring and careful consideration of their use. The long-term effects of stimulant medications are a concern due to their potential impact on cardiovascular health, growth, and psychological well-being. According to the most recent and highest quality study 1, stimulants can cause a decrease in growth velocity, with an average decrease of 1 to 2 cm in predicted adult height, although this effect may diminish over time. Additionally, stimulant medications can increase heart rate and blood pressure, although the average increases are mild and clinically insignificant, with an average increase of 1–2 beats per minute for heart rate and 1–4 mm Hg for systolic and diastolic blood pressure 1. However, a subset of individuals (5%–15%) may experience more substantial increases in heart rate and blood pressure, highlighting the importance of monitoring these vital signs in patients receiving stimulant treatment 1. Other potential long-term effects of stimulant medications include sleep disturbances, appetite suppression, and rare psychiatric effects like anxiety or mood changes. Regular monitoring by healthcare providers is essential to mitigate these risks, including blood pressure checks, heart rate monitoring, growth measurements in children, and periodic assessment of medication effectiveness. It is also important to note that the risk of sudden cardiac death among children and adolescents using stimulant medications is extremely rare and has not been shown to be increased beyond that observed in children who are not receiving stimulants 1. Overall, the long-term effects of stimulant medications vary significantly between individuals, and careful consideration of their use and regular monitoring are necessary to minimize potential risks and maximize benefits. Key considerations for healthcare providers include:

• Monitoring heart rate and blood pressure in patients receiving stimulant treatment
• Measuring growth in children to assess potential growth suppression
• Assessing medication effectiveness and adjusting dosages as needed
• Evaluating patients for potential cardiovascular risk factors before initiating stimulant therapy
• Providing education on potential long-term effects and the importance of regular monitoring.

From the FDA Drug Label

CNS stimulants have been associated with weight loss and slowing of growth rate in pediatric patients Careful follow-up of weight and height in children ages 7 to 10 years who were randomized to either methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication-treated pediatric patients over 36 months (to the ages of 10 to 13 years), suggests that pediatric patients who received methylphenidate for 7 days per week throughout the year had a temporary slowing in growth rate (on average, a total of about 2 cm less growth in height and 2. 7 kg less growth in weight over 3 years), without evidence of growth rebound during this development period.

The long-term effects of stimulant medication, specifically methylphenidate, include:

• Slowing of growth rate in pediatric patients
• Weight loss in pediatric patients
• Potential for peripheral vasculopathy, including Raynaud’s phenomenon
• Potential for psychiatric adverse reactions, such as exacerbation of pre-existing psychosis, induction of a manic episode, and new psychotic or manic symptoms
• Potential for priapism, a prolonged and painful erection
• Potential for increased intraocular pressure and glaucoma
• Potential for motor and verbal tics, and worsening of Tourette’s syndrome 2

From the Research

Long-term Effects of Stimulant Medication

The long-term effects of stimulant medication on individuals with attention-deficit hyperactivity disorder (ADHD) have been studied in various research papers.

• Studies have shown that stimulant medications, such as methylphenidate and amphetamine derivatives, are generally safe and well-tolerated, but may cause small increases in blood pressure and heart rate 3, 4, 5, 6.
• A study published in 2013 found that the risk of serious cardiovascular problems, including sudden cardiac death, associated with stimulant medications is extremely low 3.
• Another study published in 2005 found that active drug treatment for ADHD was associated with statistically significant changes in systolic blood pressure, diastolic blood pressure, and heart rate, but these changes were often minor and similar to those observed in individuals receiving placebo 4.
• A 2022 study found that long-term use of methylphenidate in adolescents and young adults with ADHD was associated with small but significant increases in systolic blood pressure and heart rate during daytime, but not at night 5.
• A 2012 review highlighted the dangers of misusing stimulants, including psychosis, myocardial infarction, cardiomyopathy, and sudden death, and emphasized the need for long-term safety studies and education on the health risks associated with misuse 7.
• A 2013 meta-analysis found that CNS stimulant treatment of ADHD in adults was associated with statistically significant increases in resting heart rate and systolic blood pressure, and a increased risk for a resting heart rate >90bpm 6.

Cardiovascular Effects

• The studies suggest that stimulant medications may have cardiovascular effects, including increases in blood pressure and heart rate, but these effects are generally minor and may not be clinically significant 3, 4, 5, 6.
• However, individuals with a personal or family history of cardiovascular disease should be treated with caution when considering stimulant medications 3.
• Regular monitoring of blood pressure and heart rate is recommended for individuals taking stimulant medications 4, 5.

Risk of Adverse Effects

• The risk of adverse effects, including serious cardiovascular problems, associated with stimulant medications is generally considered to be low 3, 7.
• However, the potential for adverse effects highlights the need for careful consideration and monitoring when prescribing stimulant medications, particularly for individuals with a history of cardiovascular disease or other risk factors 3, 7.