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Can Adderall Cause Atrial Fibrillation?

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Posted on Tue, 27 Jun 2017
Question: Two years ago I was diagnosed with polymyalgia rheumatica PMR. I took 1,000 mg of Aleve for about two years after getting off Prednizone. Inalso was taking 15mg of time released Adderral for ADD. In Feb of this year I had my blood pressure taken and it was 180/99. I went to my primary care physician who had me stop the Aleve, use Tylenol in its place, she prescribed 10 mg of Bystolic until I could get in to see the referred cardiologist and agreed with ne to stop the Adderral.

I was evaluated by a cardiologist in April. stress test, echo cardiogram, 3 days on heart monitor. I had an incident of sustained Afid 6 years earlier and intermitently had short incidents but was told I did not have Afib. So i was prescribed 20 mg of Bystolic and 10 mg of Lisinoprol. My bp went up. due to water retention on 20 mg of Bystolic. Cardiologist then abruptly stopped Bystolic (which I questioned due to what I read about stopping beta blockers abruptly) but followed instruction). then just on lisinoprol. I cannot recall the exact time period from this change, but shortly after making several adjustments to this protocol ( within a week or so) I was then hospitalized on three separate occassions in an 8 day period from May 13 - May 21 for prolonged incidents of Afib (with sustained HR above 180). the first two admissions I was discharged after an overnight stay for observation and each time my heart converted on its own back to a sinus rhythym after being on a 10mg per hour drip of diltiazem. After the first two discharges, (first with Rx of 120 mg dilitizem and 20 mg Xaralto) (second with Rx of 240 mg dilitizem and 20 mg of Xaralto) my heart went was back in Afib within 36 hours of discharge. on third admission my heart converted on its own and i was discharged after a two night stay in hospital and a consult with a cardio physiologist.

i was advised that diltiazem helped get the heart out of Afib but did not prevent it from going into Afib. i was given new Rx of 10 mg of Bystolic. 20 mg of Xaralto and 400 mg 2x a day of Multaq. This has kept my heart from going back into Afib and my bp is maintaining around 137/60 with a heart rate avg 53. So I want to try to take an Adderral to work on a few projects as it helps me a great deal to focus and get through the work. i never have monitored my heart rate while on the time released version of aadderral, but i occassionally could feel my heart race for a very short period. Before these three incidents of Afib, my cardiologist had told me I could take thecAdderral on an as needed basis, but I don't really like taking drugs so I never did.

With that background information , my question is: Given the Bystolic is keeping my heart rate in the low 50's (in 60s when walking and doing nonstrenuous things) do you think it is ok to take a 15mg time realeased Adderral while also on Multaq 800 mg day to see how it goes?
doctor
Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I passed carefully through your concern and would like to explain that Adderall has an adverse effect on atrial fibrillation occurrence and other cardiac arrhythmias as well.

Furthermore, there exists an unfavorable interaction when Adderall and Dronedarone (Multaq) are taken concomitantly. Dronedarone potentiates the pharmacological effects of Adderall and hence also its potential adverse effects by decreasing its levels.

So, as Adderall increases the adrenergic stimulation it is not recommended in your case, at least as this current history of recurrent atrial fibrillation episode is passed.

In conclusion, I would strongly recommend you to avoid taking Adderall at least for some months and meanwhile to keep consulting with your attending cardiologist in order to investigate the beneficial effects of the actual combination (dronedarone + multaq + bystolic).

During this period it is necessary a careful and periodic monitoring of your cardiac rhythm.

Hope to have been helpful to you!

Feel free to ask me again whenever you need!

Kind regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (4 hours later)
Thank you Dr. Illiri. You answered my question, as I suspected the addition of Multaq would alter the Use of Adderral.

can I ask your opinion on what steps you would recommend prior to a decision to have a carrdiac ablation? I am not certain if my payment option included this type of follow up question.

thank you for your thoughtful and thorough response. I was very satisfied with it.
XXXXXXX
doctor
Answered by Dr. Ilir Sharka (10 hours later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Dear XXXX!

Regarding cardiac ablation as an option of treating atrial fibrillation even when it is paroxysmal (AF), I would explain that it could be considered only if the current therapeutic therapy (Multaq plus Bystolic) results unsuccessful in preventing further Atrial fibrillation recurrences.

I personally believe that first we should wait and see if AFib episodes are really deteriorating or those experienced episodes were only due to inappropriate therapy modification (abrupt withdrawal of the beta-blocker plus intermittent use of Adderall).

The most common strategy is stay on a minimal anti-arrhythmic therapy considering only a few AFib episodes.

But, in the case the arrhythmia keeps recurring again though on anti-arrhythmic therapy, and these situation is obviously symptomatic (AFib episodes really disturbs your daily living activity), then cardiac ablation should be considered.

In the case cardiac ablation comes on the scene, then it should be clearly differentiated whether any structural cardiac disorders is present.

For such purpose, a careful cardiac ultrasound and cardiac MRI (magnetic resonance imaging) are necessary.

If cardiac ablation is applied for the treatment of paroxysmal AFib in the absence of structural cardiac disorders, the success rate is around 80%, but if AFib becomes persistent and furthermore structural changes are detected, then the success rate decreases to around 50%.

As you see, there may be necessary repeated cardiac ablation procedures for a complete treatment of AFib recurrences in a great proportion of such patients.

And even after repeated episodes of cardiac ablation anti-arrhythmic drugs are sometimes recommended to be continued, too.

That’s why I am somewhat reluctant of considering cardiac ablation at this stage.

We need first to carefully monitor the actual therapy efficacy and then decide if alternative options are necessary.

That’s my personal professional opinion.

In case you need to discuss further topics do not hesitate to ask me.

You may ask two further follow-up questions under the payment you have done.

After that, you may ask me also directly through the following link, if you prefer to contact me exclusively:

http://doctor.healthcaremagic.com/doctors/dr-ilir-sharka/69765

I remain at your disposal!

Best wishes,

Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9545 Questions

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Can Adderall Cause Atrial Fibrillation?

Brief Answer: I would explain as follows: Detailed Answer: Hello! Welcome on HCM! I passed carefully through your concern and would like to explain that Adderall has an adverse effect on atrial fibrillation occurrence and other cardiac arrhythmias as well. Furthermore, there exists an unfavorable interaction when Adderall and Dronedarone (Multaq) are taken concomitantly. Dronedarone potentiates the pharmacological effects of Adderall and hence also its potential adverse effects by decreasing its levels. So, as Adderall increases the adrenergic stimulation it is not recommended in your case, at least as this current history of recurrent atrial fibrillation episode is passed. In conclusion, I would strongly recommend you to avoid taking Adderall at least for some months and meanwhile to keep consulting with your attending cardiologist in order to investigate the beneficial effects of the actual combination (dronedarone + multaq + bystolic). During this period it is necessary a careful and periodic monitoring of your cardiac rhythm. Hope to have been helpful to you! Feel free to ask me again whenever you need! Kind regards, Dr. Iliri