Safest Stimulant if there are Concerns for Cardiac Issues?

[shahseh22]

I was wondering if in general, the methylphenidate groups are safer than amphetamine class if there is concern for any type of murmur (no structural lesion)? For instance, I have a pt who was stable on Concerta, he has a Still's murmur and was cleared by Cardiologist (who has not returned my calls), however, insurance is refusing to continue to cover Concerta. I was thinking of just putting him Focalin XR which insurance will cover.

Thanks

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[shahseh22]

I was just bumping this in case anyone has any literature on this.

 

[TexasPhysician]

What evidence concerns you that any stimulant is damaging to a heart with a murmur in the abscence of structural lesions, hypertrophy, or arrthymias?

 

[dl2dp2]

^^ this. There are cases where there is a known existing cardiovascular pathology (i.e. garden variety coronary artery diseases) where the patient's ADHD is so severe and longstanding that discontinuation of stimulants would clearly be more harmful. In these cases cardiology clearance for this issue specifically can be helpful.