Adderall and Heart Health: Weighing the Risks for Older Adults
Millions of Americans rely on Adderall to manage attention deficit hyperactivity disorder (ADHD). But what happens when this stimulant interacts with existing health conditions?
One 72-year-old woman, V.P., raised this very question after being diagnosed with "nonobstructive coronary artery disease" through a CT angiogram. "Do I need to stop taking Adderall?" she wondered.
This is a complex question with no easy answer. While studies on the subject have produced mixed results, Dr. Keith Roach notes, "there probably is a small increased risk of heart attack and death" associated with stimulants like Adderall.
This risk is most pronounced when starting the medication. One study cited by Dr. Roach even indicated a 3% absolute increase in the likelihood of experiencing a cardiac event within a few years, compared to individuals not taking Adderall.
V.P.’s diagnosis adds another layer of complexity. Nonobstructive coronary artery disease, while less severe than obstructive CAD, still involves plaque buildup in the arteries supplying blood to the heart.
Acknowledging these concerns, Dr. Roach recommends caution.
"I would be uncomfortable prescribing Adderall to an older person with known coronary disease."
He suggests exploring alternative options, such as nonstimulant medications like clonidine or guanfacine, which are likely to pose fewer risks.
Sodium Levels: A Mystery Unraveled?
A couple, T.D. and his wife, face a curious medical puzzle: chronically low blood sodium levels, hovering around 132, and occasionally dipping lower. While both maintain a healthy diet, their sodium levels persistently remain below the ideal range.
T.D., concerned about the potential impact on their health, sought answers from Dr. Roach. Could their medication regimen, which includes clonidine and angiotensin receptor blockers (ARBs), be the culprit?
Dr. Roach suggests their suspicions are likely on target. Medications like clonidine and ARBs have been known to cause low sodium levels, likely through their effect on hormones and kidney function.
Interestingly, both T.D. and his wife suffer from labile hypertension, experiencing spikes in blood pressure during stressful events.
Dr. Roach questions the use of clonidine, noting it’s not usually a first-line treatment for hypertension. He suggests other common choices, including ACE inhibitors, calcium blockers, and diuretics.
For those struggling with persistent high blood pressure despite medication, Dr. Roach recommends exploring medications that block the hormone aldosterone, such as spironolactone or eplerenone.
