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Most Ritalin Users Don’t Need EKGs

November 9, 1998

DALLAS (AP) _ Most youngsters on the hyperactivity drug Ritalin don’t need electrocardiograms to check for heart irregularities, the American Heart Association said Monday.

However, children taking two other types of behavior-altering drugs should undergo heart monitoring before and during treatment, the organization said.

The recommendations were outlined at a heart association meeting in Dallas.

The question of heart monitoring arose after several children taking psychotropic drugs died suddenly in the late 1980s and early 1990s.

Doctors have since noticed that the number of EKGs being ordered by child psychiatrists was increasing dramatically, said Dr. Dianne Atkins, a professor of pediatrics at the University of Iowa and a member of a heart association guidelines committee.

``We started the guidelines to actually learn whether we thought that there were excessive risks,″ Dr. Atkins said. ``At the same time, there was a lot of publication and systematic analysis of these drugs which supported the final conclusion that from a cardiovascular standpoint, they are very safe.″

Ritalin is often prescribed for children with attention-deficit hyperactivity disorder. One study found that some 1.5 million young people ages 5 through 18, or 2.8 percent of the nation’s school-age children, take the drug.

The committee concluded after examining studies and the seven deaths that EKGs should be done before and during use of two groups of drugs: tricyclic antidepressants and phenothianzines, which treat psychoses.

Those drugs can affect so-called long QT syndrome, a condition in which the heart muscle has difficulty recharging after it beats. The syndrome can be congenital or acquired by patients through heart surgery or drug treatment.

Methylphenidate, a stimulant commonly called Ritalin, and fluoxetine, or Prozac, require no specific cardiovascular monitoring under the guidelines.

However, patients with a personal or family history of palpitations, fainting or other heart problems should be evaluated by a pediatric cardiologist before starting the drugs.

And once the drug treatment begins, those patients’ hearts should be watched carefully.

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