Cardiomyopathy due to ingestion of Adderall

Cardiomyopathy Due to Ingestion of Adderall

American Journal of Therapeutics 15, 287–289 (2008)

Donald H. Marks, MD, PhD*

A patient is described who developed cardiomyopathy after receiving a therapeutic course of dextroamphetamine/amphetamine. The patient’s cardiac function deteriorated to the point of heart failure, necessitating a heart transplantation. Cardiomyopathy associated with amphetamine use is a serious and potentially lethal condition. With early diagnosis, identification of the cause, and treatment, cardiomyopathy may be reversible. The dangers of therapeutic use of amphetamines are discussed, as well as problems and assumptions associated with U.S. Food and Drug Administration monitoring and removal from the market of harmful substances.

Keywords: Adderall, Ritalin, dextroamphetamine, amphetamine, cardiomyopathy

INTRODUCTION

Amphetamines are noncatecholamine sympathomi- metic amines with CNS stimulant activity.1 As prescrip- tion drugs, they are prescribed widely for attention deficit and hyperactivity disorders.2 Of the number of adverse effects that are associated with amphetamines, one that can occur, sometimes with devastating results, is cardiovascular toxicity.3 I describe a case of cardio- myopathy leading to a heart transplantation which was causally related to the prescription drug Adderall.

METHODS

The basis of this case report was a thorough review of the medical records, a medical history and physical examination after the heart transplantation had oc- curred, and a search of the current medical literature using Medline. A determination of causal relatedness between the consumption of Adderall (Shire Pharma- ceuticals, Wayne, PA) and the development of cardio- myopathy was made by means of universally accepted algorithms,4 as described.

 Case report

The patient was a 34-year-old Caucasian man with a medical history of asthma, obesity, irritable bowel syn- drome, and genital herpes. He was given a diagnosis of attention deficit disorder and was prescribed and ingested Adderall (dextroamphetamine/amphetamine) for approximately a 2-year period.

Adderall was started initially at 20 mg daily. Two months later the dosage of Adderall was increased to 40 mg a day, and Prozac, 20 mg, was added as a mood stabilizer. Seven months later the Adderall dosage was again increased to 40 mg in the morning and 20 mg at night, as well as an increase in Prozac to 40 mg each day. The next month, the dose of Adderall was again increased, to 80 mg—three 20-mg tablets in the morning and one tablet in the evening—because the patient was still having problems with completing tasks. On the higher dose of Adderall, the patient experienced increased hyperactivity and irritability, and in response to these symptoms his neurologist rec- ommended counseling; the Adderall and Prozac regimens were continued.