Blood Pressure Monitoring After Starting Concerta in Teenagers
Blood pressure and pulse should be checked before starting Concerta, then monitored regularly during treatment—quarterly (every 3 months) for adolescents on stimulants. 1
Initial Baseline Assessment
Before initiating Concerta or any stimulant medication, obtain baseline vital signs including:
- Blood pressure measurement 1
- Pulse/heart rate 1
- Height and weight 1
- These should be obtained in the context of a routine physical examination 1
This baseline assessment helps identify adolescents who may have pre-existing hypertension or cardiac arrhythmias that could be worsened by stimulant treatment 1.
Ongoing Monitoring Schedule
For Children and Adolescents:
- Annual vital sign checks during routine physical examinations are the minimum requirement 1
- However, given that stimulants can increase blood pressure and heart rate, more frequent monitoring is prudent 2
Practical Monitoring Approach:
- Check blood pressure and pulse at each follow-up visit during the initial titration phase (typically every 1-4 weeks as dose is adjusted) 1
- Once stabilized on medication, quarterly monitoring (every 3 months) is recommended for adolescents on stimulants 1
- This can be performed by either the prescribing physician or the primary care physician 1
Important Clinical Considerations
Red Flags Requiring Immediate Attention:
Contact the healthcare provider or go to the emergency room if the teenager develops: 2
- Chest pain
- Shortness of breath
- Fainting or syncope
Risk Stratification:
The FDA label warns that stimulants like Concerta carry cardiovascular risks, particularly: 2
- Sudden death has occurred in patients with heart defects or serious heart disease
- Increased blood pressure and heart rate are expected effects of treatment
Common Pitfall to Avoid:
Do not assume that because a teenager had normal blood pressure at baseline, ongoing monitoring is unnecessary. Stimulants can elevate blood pressure over time, and regular surveillance is essential to detect treatment-emergent hypertension 1, 2.
When to Consider More Intensive Monitoring
If blood pressure becomes elevated during treatment (≥90th percentile for age, sex, and height), follow pediatric hypertension guidelines: 1, 3
- Repeat measurements on multiple occasions to confirm
- Consider lifestyle modifications
- May need ambulatory blood pressure monitoring (ABPM) to exclude white coat hypertension 4
- Evaluate for need to adjust or discontinue stimulant medication