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General Medication Discussion This section is to be used for general medication discussion and other medications not broken out in their own respective forums.

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  #1  
Old 11-16-04, 08:37 PM
ADDition ADDition is offline
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Medication ideas for person with cardiac issues

Greetings all-this is my first post on the forum. I have been formally diagnosed ADHD and am in my 30's. Had a psychological evaluation after I suspected ADHD. Well-it was certainly confirmed. I want to see a medical doctor for medication evaluation, but I do have some cardiac issues (nothing sustained, but nonetheless part of my history, which could very well rule out the stimulant type medication). I'm wondering if anyone here takes any of the medications and also has a cardiac issue. In particular, I'm wondering then if I ought to look into Straterra, but have of course heard that it is not as effective as the stimulants. Nonetheless, I don't want to mess with cardiac issues. I also know medication is not a cure-all, but I need all the assistance I can get with my chaotic life. I'm so tired of living this way-any improvement will be like heaven to me. Thanks all.
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Old 11-17-04, 01:48 AM
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I had congenital pulmonary stenosis which was corrected by surgery when I was 7. My psychiatrist initially prescribed me Strattera, and, later, Wellbutrin. I'm doing well on the combination.

You don't mention what kind of cardiac issues you have, but it might be worth getting examined by a cardiologist. I'm seeing one next week and definitely plan to ask him if I could ever take stims, if necessary.
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Old 11-17-04, 02:44 AM
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I would think Ritalin/Concerta would be fine. Adderall might be too much depending on what problems you had. But ADD drugs carry a lot of negative baggage that is largely unwarranted. By and large they are one of the safest classes of drugs in use today.
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Old 11-17-04, 11:22 AM
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If the cardiac issues aren't too serious you can often take stimulants, although I imagine they are careful on the dosage. And it depends on what the problem is exactly. Stimulants will increase your blood pressure and heart rate, and so will some of the other drugs used to treat ADHD like Wellbutrin for example. Usually these effects wane with time.
Strattera isn't necessarily less effective than stimulants. Anicdotal evidence suggests that it works in a smaller percentage of people than stimulants do, and it's effectiveness seems rather "black or white" it either works well, or not at all, whereas stimulants seem to work more on a sliding scale. How well anything works for you will depend pretty much on your own brain chemistry - everybody is different.
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Old 11-17-04, 11:43 AM
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I have PVC's and am on Adderall.

I concur with talking with your dr. Seems the best course to me.
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Old 11-17-04, 11:45 AM
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This one is not available in the US and not mentioned as a stimulant for ADD but it does definitely work that way:

http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=2698275
"It is well known that the antidepressive treatment of the aged imposes particular problems because of the frequent presence of cardiovascular problems, ocular hypertension, and prostatic hypertrophia. Amineptine (Survector 100) is devoid of anticholinergic and cardiotoxic effects. For this reason we have studied it in the treatment of elderly depressed patients....

The overall clinical efficacy was positive in 68% of cases; the clinical judgment was confirmed by a decrease in the mean score of HDRS (after the 7th day). The good acceptability (clinical, cardiovascular) was also confirmed. The different biochemical parameters were generally not modified during the treatment. Amineptine appeared to be an antidepressant treatment that combines efficacy and a very good level of safety, essential qualities for the treatment of elderly depressed patients."


Another one I know less about but I think you could actually get a prescription for in the US and is also recommended for elderly is ADRAFINIL (Olmifon)
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Old 11-17-04, 06:11 PM
ADDition ADDition is offline
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Thank you all!! I will try to address everyone's comments in one fell swoop, but will have to keep referring to the posts, so hopefully I will give the reply I'm trying to. (in ADHD fashion, I often can't recall what I just read).

Exeter, as far as my cardiac issues, they are of a arrythymia nature, and as you pointed out Gregster, stimulants increase the heart rate. I have mitral valve prolapse, along with one documeneted episode of non-sustained ventricular tachycardia, for which I do take a beta blocker. I have a history of PVC's, but my heart rate usually is fine on an EKG. I do have a cardiologist, so perhaps my primary care doctor can consult with him. My primary is who I'm seeing about medication. I did have a doctoral level psychologist assess me. I've read up on the various ADHD meds, and I have read the cautions on administering them to people with arrythmias. One of the stimulants pretty much stated it was contraindicated. But kittyinjammies, you have PVC's and take Adderall. andocrates,yes, I wonder too that Ritalin or Concerta might still be okay versus say Dexedrine, although I don't know for sure until I ask. paulbf, thank you. I like to investigate innovative approaches too, and I will look up that medication.
Thank you again. I see my physician tomorrow and I'll let you all know what happens.
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Old 11-18-04, 02:41 AM
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Sounds like a good idea to get your ADHD doc and your cardiologist to put their heads together. I'd at least talk to the cardiologist about stimulant meds. If they can aggravate premature ventricular contraction or bring on v-tach, I'm sure the cardiologist will know.
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Old 11-18-04, 10:14 AM
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The arrythmia will probable keep you off of stimulants - the cardiologist will be making that call, I should think.
Let us know what your Doctor says, I am very interested in what they do in these cases.
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Old 11-18-04, 11:54 PM
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I saw my primary care doctor this evening and he is updated on my official ADHD status. I explained that I would like to try medication. He was hesitant, saying he'd prefer me to see a specialist, but was willing to go ahead. Because of my cardiac arrythmia history, he flat out declined to consider any of the stimulant medications. He only would if my cardiologist were to clear it, which he didn't seem to think would be high odds. So my options are Strattera or Wellbutrin. I thought it over, and decided I might as well try Strattera first. I'll be on 40mg for a few weeks, and have a return appointment next month so that my physician can check my progress and adjust the dosage. He said I should give it a few months to see if there is any response. I figure this is a good plan. I need to schedule my annual check-up with my cardiologist anyway, so whenever I see him, I figure I can run this by him, but I do think I need to give the Strattera a chance first anyway, and play it by ear. If it helps, then great, it will be what I use to help manage my ADHD. And well, that's life-I have the caridac history contraindication, and can't change that, so I'll do the best I can with what I have to work with. Anyway, I will take my first Strattera dose tomorrow. Keeping my fingers crossed and will see what happens. I know it will take a little time to see if I get a response.
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Old 11-19-04, 02:03 AM
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If Strattera or Wellbutrin don't do it alone, I'd consider trying a combination of the two. My psychiatrist has several patients on that combination who are doing much better than on the individual meds. There are also a few other meds you *could* try, like desiprimine, but there are generally good reasons why they are not first or second-line treatments for ADD (side effect and effectiveness profiles are not as good as stims, Strattera, or Wellbutrin, basically).
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Old 11-22-04, 12:44 AM
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Exeter:
Thanks for the suggestion to consider a combination of Strattera and Wellbutrin. I'm going to see how the Strattera goes and take it from there, but the combination idea is in the back of my head. In fact, I did mention it to my dr- that is, whether I could take both together, but he seemed to prefer an either/or, so I figured I'll start with just one, and look into re-visiting the combo idea if need be. I've taken 3 days of Strattera so far with no noticeable side effects, thank goodness. I hope I will see a response, but will have to wait and see.
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Old 11-22-04, 12:56 AM
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Well, no side effects is a good start! I certainly understand preferring an either/or approach... many people have a degree of polypharmacy going on due to multiple prescription medications. Me, I need a degree *in* polypharmacy to figure stuff out sometimes.

I'm seeing a cardiologist this week, too, and I'll definitely ask him if it would be safe to take stims if I ever needed. If I remember, I'll post on here. If not, someone PM me at the end of the week and remind me... lol.
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Old 11-23-04, 12:48 AM
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I too, will post after I hear what my cardiologist has to say, and will be curious to hear of the outcome of your visit. Of course, it would help if I schedule my appointment in the first place. I'll bet I won't get in until January anyway at this point! Procrastination is one of my ADHD related downfalls. And this is my annual appointment I need, unrelated to consultation regarding medication. It should already be scheduled, but alas, scattered me hasn't called yet. But I will guess that my cardiologist will not want me on stimulants. Well, I'm glad there are alternatives. I'll deal with what I have to there.
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