Medications for attention deficit hyperactivity disorder associated with increased risk of developing glaucoma

Key Takeaways

  • New research suggests that ADHD medications can increase the risk of developing both angle closure and open angle glaucoma.
  • Given the prevalence of ADHD medication use, their associated risk of glaucoma may have profound public health implications.

Attention deficit hyperactivity disorder (ADHD) therapies including atomoxetine, methylphenidate, and amphetamines are some of the most prescribed medications in North America. These drugs are contraindicated in patients with a history of angle closure glaucoma (ACG), a type of glaucoma characterized by blockage of the drainage angle, but their effect on open angle glaucoma (OAG) is unknown.

Rami Darwich and colleagues conducted a retrospective cohort study with a case control analysis using the PharMetrics Plus Database to study the relationship between ADHD medication use and glaucoma. (A retrospective cohort study uses the medical records of groups of individuals who are alike in many ways but differ by a certain characteristic, e.g., ADHD medication use). The team created a cohort of new users of atomoxetine, methylphenidate, and amphetamines and they were followed to the first diagnosis of (1) ACG or OAG; or (2) end of follow up. For each case, four age-matched controls were selected. A total of 240,257 new users of the ADHD medications were identified.

The researchers found that patients who used amphetamines and atomoxetine had a higher risk for ACG, while use of methylphenidate was associated with a higher risk for OAG. The authors conclude, “Given the prevalence of ADHD medication use (medically and recreationally), our current data on their associated risk of glaucoma have profound public health implications”.

Source: Darwich, R., et al, Eye, May 6, 2024; https://doi.org/10.1038/s41433-024-03100-6