Is Dextroamphetamine contraindicated for heart conditions?

Question

Hello doctor,

I am a 55-year-old woman recently diagnosed with ADHD (attention deficit hyperactivity disorder) and prescribed stimulants. I have hypertension and take Amlodipine 5 mg, Losartan 50 mg, and Propranolol (10 mg to 60 mg) for anxiety, which also helps with my blood pressure. My echocardiogram indicates that my left ventricular wall thickness is mildly increased, with grade 1 diastolic dysfunction of the left ventricle (impaired relaxation pattern) and normal left ventricular systolic function. Everything else on the echocardiogram is normal.

Is taking a Dextroamphetamine prescription of 5 mg ER and 5 mg IR per day contraindicated with my condition? This is the lowest dose of Dextroamphetamine, but it significantly helps with my ADHD and anxiety symptoms. The stimulants do not appear to increase my blood pressure, although my blood pressure is not completely controlled; it is usually around 130 over 85. I am scheduled for another echocardiogram next month.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Currently, you do not have any serious heart issues. The impaired relaxation and diastolic dysfunction are due to chronically elevated blood pressure, leading to hypertrophy. This is not a serious heart problem and does not require specific treatment; it is similar to the muscle development seen in athletes due to increased workload.

Regarding Dextroamphetamine, the contraindication is not related to your heart but rather to high blood pressure. It is contraindicated in cases of moderate to severe uncontrolled hypertension. Given that you are on the lowest possible dose and have observed that it is not affecting your blood pressure readings, Dextroamphetamine can be continued. However, please keep monitoring your blood pressure.

The blood pressure reading you mentioned is acceptable, and you should continue the same antihypertensive medications. If necessary, we can increase Amlodipine to 10 mg. As for cholesterol, your LDL levels are significantly high. I recommend vigorous lifestyle modifications. If you are already making such changes, it may be beneficial to initiate medication like Rosuvastatin at bedtime. Adopting a healthy lifestyle is crucial. You should avoid fatty, oily, and high-calorie foods, as well as follow a low-salt diet. Engage in regular exercise, such as brisk walking or jogging, for at least 30 minutes a day, five days a week, according to your capacity. Incorporate plenty of green leafy vegetables, fruits, and fish into your diet, limiting meat consumption. Avoid smoking and alcohol, if applicable.

Aim to lose some weight to lower your body mass index (BMI). Recheck your cholesterol levels after two to three months. If there is an improvement, that is great; otherwise, you may need medication.

I hope this helps, and feel free to reach out if you have any questions.

Thank you.