Posted by Astounder on November 15, 2007, at 22:24:40
In reply to Cardiovascular toxicity of stimulants, posted by kaleidoscope on November 13, 2007, at 15:16:03
> Long-term use of stimulants may increase the risk of cardiovascular disease. This is a major concern. Stimulants constrict blood vessels and elevate BP. They also increase heart rate and cardiac work. Regular BP monitoring is very important when taking stimulants. High BP causes heart attacks and strokes, even small increases in BP of a few mmHg produce a large increase in risk. In addition, stimulant use has occasionally been associated with strokes and sudden cardiac death in children. Numerous cardiovascular warnings have recently been added to the prescribing information for all stimulants ie. Adderall, Ritalin, Concerta, Dexedrine etc.
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> Drugs which inhibit the sympathetic nervous system (eg. beta blockers such as Toprol) are used to prevent heart attacks. Stimulants may increase your risk. This important issue has received very little research attention, which is really very poor considering how frequently these drugs are prescribed in the US...... and I say the US because stimulants are used so much less commonly in most countries. The US is without a shadow of a doubt the stimulant capital of the world! I think this has a lot to do with a culture of academic achievement in combination with the widespread medicalisation of normal symptoms which affect most people eg. poor attention, daydreaming, dislike of boring school/college work. Pharmaceutical companies are phenomenally influential in the US and are very very apt at promoting their products.........which are approved based on short-term efficacy studies and lack of long-term safety data. Although stimulants have been used in medicine for decades, their long-term cardiovascular safety has never been properly investigated. In the absense of proper trials, it would be foolish to assume that they are safe, particularly when you consider the effectiveness of drugs which block the effects of the sympathetic nervous system in preventing heart attacks and strokes. In addition, beta blockers and related drugs increase survival in patients with established cardiovascular disease. Given that most cardiovascular disease occurs in adults, and not children, the recent trend toward prescribing stimulants to large numbers of adults with ADHD is a concern.
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>There's little evidence that beta blockers do any good in healthy persons, indeed they have become disused for treating high blood pressure because of the diabetes risk.
The sympathetic nervous symptom is important in preventing and reversing obesity and insulin tolerance. Although beta blockers increase exercise tolerance, they abolish the positive effects of chronic exercise on triglyceride & cholesterol levels and insulin sensitivity (by preventing lipid mobilization, lipid uptake, insulin & glucose uptake, and consequent lipolysis & glycolyis). The metabolic syndrome is a far greater early predictor of heart disease than elevated BP & HR, and while the hypertension is easily reversed by stimulant discontinuation and antihypertensive drugs therapy (for which there are far more efficacious drugs now than beta blockers), treating type II diabetes & obesity is much more involved.
That said, I'd definitely advocate the discontinuation of stimulants after infarction and putting the person on beta-blockers. Since there's an overwhelming amount of evidence they decrease mortality post-infarction.
Another issue is that orthostatic hypotension, as the result of sympathetic insensitivity, is the biggest cause of falls in the elderly; treatment is routinely ignored, even when there are highly efficacious OTC drugs like pseudoephedrine. Drugs like pseudoephedrine are now a subject of controversy; we've seen the removal of effective sympathomimetic decongestants & OTC anorectics like phenylpropanylolamine, and restriction on sale of ephedrine & pseudoephedrine, largely replacing them with phenylephrine (a drug which metastudies show is no more than a placebo).
There are deaths attributable to these drugs, however the incidence of death is not much more than fatal liver failure from acetaminophen. I suspect that FDA rulings on these drugs were largely political in nature, to squelch outcry against their regulation by the Combat Meth Epidemic Act.
poster:Astounder
thread:794670
URL: http://www.dr-bob.org/babble/20071115/msgs/795385.html