New Guidelines for Starting an ADHD Medication While in Quarantine
The European ADHD Guidelines Group (EAGG) recommends that patients who didn’t have an in-person assessment before stay-at-home orders began should delay starting a new medication if they have a history of shortness of breath or a family member who died due to cardiac disease. Patients should also undergo baseline monitoring — having their blood pressure and heart rate taken — before beginning medication.
May 21, 2020
In light of the COVID-19 pandemic and widespread stay-at-home orders, the European ADHD Guidelines Group (EAGG) has released guidance1 for patients who wish to start a new ADHD medication (specifically psychostimulants and atomoxetine) but did not complete an in-person cardiovascular assessment prior to the quarantine. Starting a new medication under these circumstances was deemed appropriate only if three conditions are satisfied:
- The individual with attention deficit hyperactivity disorder (ADHD) should not have a personal history of “shortness of breath on exertion compared with peers; fainting on exertion or in response to fright or noise; excessive palpitations, breathlessness or syncope (at rest or after exercise) or palpitations that are rapid, regular, and start and stop suddenly (fleeting occasional bumps are usually ectopic and do not need investigation); chest pain suggesting cardiac origin; or any previously documented hypertension, congenital heart abnormality, previous cardiac surgery, or underlying condition that increases the risk of having a structural cardiac disorder (eg, genetic conditions or multisystemic disorders).”2
- The individual with ADHD should not have a family member who died a sudden, early death (younger than 40 years of age) due to cardiac disease.
- Baseline monitoring of health, such a checking blood pressure and heart rate, has been conducted by a family member or another person remotely.
If the first two conditions are not met, medical practitioners should postpone treatment changes until a referral to a cardiologist is issued. If the individual with ADHD is unable to conduct baseline monitoring, the EAGG states that the prescriber must evaluate the risks and benefits of an in-person assessment in light of the severity of ADHD symptoms and the effect it could have on the patient and their family. If the risk factors described in the first two conditions are not present, the EAGG states that a cardiac auscultation isn’t necessary before starting ADHD medication.
1Starting ADHD medications during the COVID-19 pandemic: recommendations from the European ADHD Guidelines Group. The Lancet: Child and Adolescent Health (May 2020). https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30144-9/fulltext
2National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management, NICE guideline [NG87] (Sept 2019). https://www.nice.org.uk/guidance/NG87
Updated on May 21, 2020