- In a series of 16 patients who developed vascular symptoms while on prescription amphetamine, most were women ages 20 to 40
- Six of the patients developed severe vascular manifestations, of whom three required finger or lower-leg amputation
- Symptoms can occur in anyone, but rheumatological conditions predispose to even more severe manifestations
- Clinicians should search for amphetamine use in the history of patients presenting with vasospastic disorders
The use of prescription amphetamine and its related derivatives and analogs (ADRA) has been reported to be associated with acute coronary syndrome. However, there are few reports of peripheral vascular disorders in adults who use ADRA.
Researchers at Massachusetts General Hospital led by Ido Weinberg, MD, director of the Vascular Medicine Fellowship, recently published in Vascular Medicine, a case series that describes clinical characteristics and outcomes of patients with peripheral arterial manifestations and a history of ADRA use. They determined that concomitant rheumatologic disease is a risk factor for severe vascular manifestations.
The researchers followed 16 adults who presented to Mass General's Vascular Medicine Service from May 2000 to December 2017 for evaluation of vascular symptoms while on ADRA. Thirteen patients were female, of whom eight were 40 years of age or younger. The median age of the cohort was 37 years (range, 20–57 years). The median follow-up was 3 years.
All patients were taking Adderall (amphetamine plus dextroamphetamine). Twelve patients had a psychiatric diagnosis (anxiety, n=8; attention deficit hyperactivity disorder, n=1; bipolar disorder, n=1; obsessive-compulsive disorder, n=1). The others had no recorded indication for taking Adderall. Four patients had a rheumatologic disorder (systemic sclerosis, n=3; lupus, n=1).
Twelve patients continued to use Adderall even after they were given a diagnosis of possible drug-induced vasculopathy. The researchers say this supports the notion that prescription ADRA use can be addictive.
Eight of the patients were smokers, and two of them had additional cardiovascular risk factors (diabetes and hypertension, plus end-stage renal failure in one). Six patients were using a vasoactive medication (beta-blocker, n=3; beta-blocker plus calcium channel blocker, n=1; calcium channel blocker alone, n=1; sildenafil, n=1).
Most of the patients had only mild symptoms (self-limiting acrocyanosis and Raynaud phenomenon). However, six patients developed severe vascular manifestations, which were evaluated with digital subtraction angiography:
- Four had severe finger ischemia, including two who required amputation due to gangrene (both were smokers)
- One had tibial artery occlusion but recovered with endoscopic revascularization (this patient had three established cardiovascular risk factors)
- One had right foot gangrene that required below the knee amputation (this patient had four established cardiovascular risk factors)
Because the number of patients was small, the researchers performed Spearman's correlation analysis. It showed that only the presence of rheumatologic disease seemed to be associated with severe vascular manifestations.
The researchers recommend that when patients present with vasospastic disorders, ADRA use should be part of the differential diagnosis. When appropriate, patients should be advised to withhold ADRA, especially if they have concomitant rheumatologic disease.
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