Objective:

To assess the All of Us (AOU) Database for Vascular Dissections occurring in patients prescribed amphetamine, dextroamphetamine, atomoxetine, and methylphenidate.

Background:

Greater than 5% of the American population use prescribed stimulants, including Adderall. Patients with connective tissue disease and other comorbidities may be at increased risk for sequelae of stimulants, including arterial dissection. This study seeks to analyze the All of Us Database to assess the prevalence of arterial dissection in patients prescribed Adderall.

Design/Methods:

A cohort of patients prescribed Adderall, methylphenidate, and atomoxetine was selected in the AOU. Analysis was conducted by assessing the first exposure date and last recorded drug/condition date. Follow up time was calculated as the last observation date subtracted by first exposure to the prescribed drug. Arterial dissection was assessed using post-exposure ICD-10 codes (I67.0, I77.7x series). Dissections only following drug exposure were included. Pairwise Poisson rate tests were used to compare incidence rates across drugs.

Results:

515,333 labeled exposures to methylphenidate, Adderall, and atomoxetine were identified in the database. 6217 participants were exposed to Adderall, 3629 exposed to methylphenidate, and 1161 exposed to atomoxetine. 15 patients (incidence of 0.9589 per 1000 person years) of patients on Adderall, 11 (incidence of  1.2018 per 1000 person years) of patients on methylphenidate, and 3 (incidence of 2.0481 per 1000 person years) of patients on atomoxetine displayed a recorded arterial dissection. Reported incidence in the literature is 0.049-0.09 per 1000 person years. Between-group comparisons of Adderall, methylphenidate, and atomoxetine were not found to be significant.

Conclusions:

Limited conclusions can be assessed without further controlling for other prescriptions, co-morbidities, and risk factors for dissection. This study displays an elevated risk profile compared to the literature-reported incidence. We recommend further investigation of the effect of prescription stimulants on arterial dissection.