Psikostimülan İlaç Kullanımına Bağlı Gelişen Supraventriküler Taşikardi
Özet
Dikkat eksikliği hiperaktivite bozukluğu (DEHB) çocuk ve ergenlerde en sık tespit edilen nörogelişimsel bir bozukluk olup erişkinlik döneminde de görülmektedir. DEHB olan bireylerin akademik ve sosyal başarısını artırmak için sıklıkla psikostimülan ilaç tedavisi kullanılmaktadır. Metilfenidat, DEHB tedavisinde kullanılan psikostimülan grubu bir ilaç olup dopamin ve noradrenalin geri alımını inhibe ederek etki göstermektedir. Sempatomimetik etkiden dolayı nadiren kardiyak aritmilere yol açabilir. Kardiyak aritmiler, daha çok yatkınlığı olan bireylerde görülmektedir. Bu makalede, aritmi yatkınlığı olmayan DEHB tanılı bir bireyde metilfenidat kullanımı sonrasında ablasyon gerektiren supraventriküler taşikardi olgusu sunulmaktadır. Bu olguların yönetiminde dikkat edilmesi gereken konular tartışılmıştır.
Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood and also occurs in adulthood. Psychostimulant medication is frequently used to improve the academic and social success of individuals with ADHD. Methylphenidate is a psychostimulant used in the treatment of ADHD that acts by inhibiting dopamine and norepinephrine re-uptake. Due to its sympathomimetic effect, it can rarely cause cardiac arrhythmias. Cardiac arrhythmias are more common in individuals with a predisposition to them. This article presents a case of supraventricular tachycardia requiring ablation following methylphenidate administration in an individual with ADHD who did not have a predisposition to arrhythmias. Considerations for managing such cases are discussed.
Referanslar
Lappin JM, Sara GE. Psychostimulant use and the brain. Addiction. 2019 Nov;114(11):2065-2077. doi: 10.1111/add.14708.
Kessler L, Hopkins A, Bahrke J, Kunstman K. An Overview of Adolescent Psychostimulant Use. Pediatr Ann. 2023 May;52(5):e170-e177. doi: 10.3928/19382359-20230307-05.
Song J, Park SJ, Yu J, Chung J, Jeong S, Park SM. ADHD and Methylphenidate Use in Prepubertal Children and BMI and Height at Adulthood. JAMA Netw Open. 2026 Jan 2;9(1):e2552019. doi: 10.1001/jamanetworkopen.2025.52019.
Shin JY, Roughead EE, Park BJ, Pratt NL. Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study. BMJ. 2016 May 31;353:i2550. doi: 10.1136/bmj.i2550
Lowenstein C, Kamdar N, Rehkopf DH. Trends in Youth Mental Health Among Patients in Family Medicine Practices: 2017-2023. Pediatrics. 2026 Apr 13:e2025072305. doi: 10.1542/peds.2025-072305.
Altay MA, Görker I, Demirci Şipka B, Bozatlı L, Ataş T. Attention deficit and hyperactivity disorder and psychiatric comorbidities. Euras J Fam Med 2020;9(1):27-34. doi:10.33880/ejfm.2020090104
Altay MA, Görker I. Assessment of Psychiatric Comorbidity and WISC-R Profiles in Cases Diagnosed with Specific Learning Disorder According to DSM-5 Criteria. Noro Psikiyatr Ars. 2017 Dec 22;55(2):127-134. doi: 10.5152/npa.2017.18123
Castillo Díaz F, Neumann ID, Rappeneau V. Oxytocin and dopamine in psychostimulant-induced changes in social behaviour. Front Neuroendocrinol. 2025 Jul;78:101200. doi: 10.1016/j.yfrne.2025.101200
Scahill L, Carroll D, Burke K. Methylphenidate: mechanism of action and clinical update. J Child Adolesc Psychiatr Nurs. 2004 Apr-Jun;17(2):85-6. doi: 10.1111/j.1744-6171.2004.00085.x
Hammerness PG, Karampahtsis C, Babalola R, Alexander ME. Attention-deficit/hyperactivity disorder treatment: what are the long-term cardiovascular risks? Expert Opin Drug Saf. 2015 Apr;14(4):543-51. doi: 10.1517/14740338.2015.1011620
Altay MA,. Does attention deficit hyperactivity disorder have cardiac arrhythmia potential? Anadolu Psikiyatri Derg 2018; 19(6):624-630
Martinez-Raga J, Knecht C, Szerman N, Martinez MI. Risk of serious cardiovascular problems with medications for ADHD. CNS Drugs. 2013;27(1):15–30.
Lee MJ, Huang CW, Hung TH, Chen YL, Chen VC. Use of methylphenidate and the risk of cardiovascular diseases in children and adolescents with a family history of heart diseases and congenital heart diseases: A self-controlled case series study. Eur Child Adolesc Psychiatry. 2026 Feb;35(2):631-639. doi: 10.1007/s00787-025-02882-8
Schneider BN, Enenbach M. Managing the risks of ADHD treatments. Curr Psychiatry Rep. 2014 Oct;16(10):479. doi: 10.1007/s11920-014-0479-3.
Spiller HA, Hays HL, Aleguas A Jr. Overdose of drugs for attention-deficit hyperactivity disorder: clinical presentation, mechanisms of toxicity, and management. CNS Drugs. 2013 Jul;27(7):531-43. doi: 10.1007/s40263-013-0084-8
Hammerness PG, Wilens TE, Berul CI, Elkort MS. Supraventricular tachycardia in an adolescent with attention-deficit/hyperactivity disorder (ADHD). J Am Acad Child Adolesc Psychiatry. 2008 Feb;47(2):219-220. doi: 10.1097/chi.0b013e31815d7485
Hammerness PG, Wilens TE, Berul CI, Elkort MS. Supraventricular tachycardia in an adolescent with attention-deficit/hyperactivity disorder (ADHD). J Am Acad Child Adolesc Psychiatry. 2008 Feb;47(2):219-220. doi: 10.1097/chi.0b013e31815d7485
