Antihypertensive medication for ADHD?

Should the antihypertensive medications be used for ADHD?

A small number of research papers appeared the in the late 1980’s suggesting that the antihypertensive medications such as clonidine (Catapres) may be beneficial to the management of ADHD symptoms, particularly in relation to reducing hyperactivity and over-arousal symptoms. It is believed that the drug acts as an alpha-2-adrenergic agonist that ultimately inhibits the release of norepinephrine, increases dopamine turnover, and reduces blood levels of serotonin. It is possible however, that the behavioral changes may be the result of general sedation. A large study in the Netherlands reports significant improvements in behavior in hyperkinetic children placed on this medication. Limited research today indicates however that clonidine is much less effective than the stimulants at improving symptoms of inattention and school productivity, but may be equally effective in the reduction of hyperactivity and moodiness. The drug may also be useful in managing the sleep disturbance that some ADHD children experience.

There was a recent trend in clinical practice in combining clonidine with Ritalin (methylphenidate) which was highly questioned on July 13, 1995, in which several cases of sudden death in children using this combination was reported on National Public Radio. Although an investigation into these cases did not provide convincing evidence that this drug combination resulted in these fatalities, several prominent investigators have raised serious questions about combining these medications given what is known about the pharmacology of both, and the utter lack of research on the effectiveness and safety of this combination. Additional cases involving significant side effects apparently resulting from this combination, were also reported fairly recently (1997). Some experts have recommended that clonidine be utilized in the treatment of ADHD only when stimulants have proven ineffective or are contraindicated. This seems to be sound advice in view of the limited scope of research to date on the use of this medication for the management of ADHD symptoms. Its combination with the stimulants should be undertaken only in very rare cases with the utmost of care and monitoring; at least until more recent research on this drug combination becomes available.