Host: What are the side effects of these stimulants, it could be lack of sleep may be they don't gain weight as well etcetera?
Dr. Steven Pavlakis: Yes, children that are very small, that can be an issue, and bigger kids it's not usually a major problem.
Host: This sees to be a phenomenon going on colleges, a lot of kids who are normal are trying to take these kind of medicines, is that somewhat of the danger?
Dr. Steven Pavlakis: Sure and sometimes kids in college will take lots of it. They will take it to stay up to study. They may even take it recreationally if you take 100 of these pills and squeeze them down and take it all at once. So there is a real risk for abuse of these medications some more than others.
The major risk is if you take a lot of this stuff it can have cardiovascular effects meaning they can increase heart rate and blood pressure which can be bad for you.
Host: If a kid had underlying cardiac problem undiagnosed is there any risk of taking these medicines?
Dr. Steven Pavlakis: Taking it properly there is probably very, very, very little risk. There is some data that even taking a regular dose may increase your blood pressure just a little bit. There is really right now no clear data of it giving this to a large population that increases a risk of any individual patient. I think it's more of a theoretical risk. So if the child does have a heart problem that we know of we certainly would have that patient cleared before giving these medications.
Host: Several months ago there was some report of 25 kids allegedly died taking a stimulant, you feel this just happens to be 25 kids to die and happened to be under medicine or there is a risk factor?
Dr. Steven Pavlakis: Well, I think every medicine has every risk known in the world and we know that people can die from Tylenol and Motrin and everything else including Benadryl, but it's very rare. The risks, the actual death rates from these medications that I have seen are no worse than people not on the medications. There was one of the medications specifically Advil was actually banned in Canada for a short period of time because they had a few children that died, but when they looked at the data as far as it could be determined the risk of death in children on Advil was not higher than the risk of death in children not on medication.
Host: Is there any medicine that doesn't simulate the body and controls kids who have --?
Dr. Steven Pavlakis: Yes, there are several. These are what I term second line medications. The best honestly is, well, there are probably two best studies, it is Clonidine or Catapres which is an old blood pressure drug, but that actually was studied for safety and for effectiveness with Ritalin in a study sponsored by the NIH about five years ago, and was found to be safe for the high blood pressure with Ritalin and without Ritalin, and also did work. So this a second line drug that I sometimes give as a patch. Other second line medications are Strattera which is related a little bit to an anti-depressant. Strattera came about four years ago. But this medication has certain advantages and certain subgroups and certain disadvantages and others, and sometimes people have used other medications including Well-butrin which some of you may know is a medication that's used to stop smoking in adults. There had been some data that this can be helpful. But the best study in second line drugs really are Clonidine or Catapres and Strattera, the newer medication that was developed just for ADHD.
Host: So in other words it's a problems that can be controlled somewhat with medicine, the rough values obviously, and a doctor who gives the medicine has to monitor it very, very carefully, is that true?
Dr. Steven Pavlakis: That's correct and furthermore is one shouldn't be rushing to give medicine to any child, and I think one warning for a parent is that if you go to the doctor and they want to give medicine on the first visit that should be a warning sign. Otherwise some children actually do need them on the first visit, they are getting thrown out of first grade because they are off the banisters and running around, but for most children it shouldn't be something that should be given without going through the scales and discussing risk factors and side effects. And I think most careful neurologists or psychiatrists will not rush into giving stimulants on the first visit unless are even worked out with great detail.
Host: So in other words, there is no side effect to any drug they don't prescribe.
Dr. Steven Pavlakis: That's correct and all drugs have every known side effect and that's always the risk, but these drugs in general are very safe, but should only be given if one is relatively sure a child has ADHD first, and secondly, if one is relatively sure that that child is falling behind in a way that's effecting their academic or social or their frustration threshold which is actually a major issue because once a child falls behind because of ADHD they become quite frustrated and can get depressed secondarily to it.
Host: So a doctor should discuss the risk and benefit from all medication use.
Dr. Steven Pavlakis: That's correct, and I think that any parent should really be vary, if a patient walks in and the doctor wants to give you Ritalin for example on the first visit without doing scales and without going over the risk and may be seeing the patient probably twice before starting it.
Host: Thank you!
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