Valvular heart disease associated with fenfluramine-phentermine.
BACKGROUND
Fenfluramine and phentermine have been individually approved as anorectic agents by the Food and Drug Administration (FDA). When used in combination the drugs may be just as effective as either drug alone, with the added advantages of the need for lower doses of each agent and perhaps fewer side effects. Although the combination has not been approved by the FDA, in 1996 the total number of prescriptions in the United States for fenfluramine and phentermine exceeded 18 million.


METHODS
We identified valvular heart disease in 24 women treated with fenfluramine-phentermine who had no history of cardiac disease. The women presented with cardiovascular symptoms or a heart murmur. As increasing numbers of these patients with similar clinical features were identified, there appeared to be an association between these features and fenfluramine-phentermine therapy.


RESULTS
Twenty-four women (mean [+/-SD] age, 44+/-8 years) were evaluated 12.3+/-7.1 months after the initiation of fenfluramine-phentermine therapy. Echocardiography demonstrated unusual valvular morphology and regurgitation in all patients. Both right-sided and left-sided heart valves were involved. Eight women also had newly documented pulmonary hypertension. To date, cardiac surgical intervention has been required in five patients. The heart valves had a glistening white appearance. Histopathological findings included plaque-like encasement of the leaflets and chordal structures with intact valve architecture. The histopathological features were identical to those seen in carcinoid or ergotamine-induced valve disease.


CONCLUSIONS
These cases arouse concern that fenfluramine-phentermine therapy may be associated with valvular heart disease. Candidates for fenfluramine-phentermine therapy should be informed about serious potential adverse effects, including pulmonary hypertension and valvular heart disease.
Connolly
H M
HM
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Crary
J L
JL
McGoon
M D
MD
Hensrud
D D
DD
Edwards
B S
BS
Edwards
W D
WD
Schaff
H V
HV
D000328:Adult; D001022:Aortic Valve Insufficiency / Q000139:chemically induced / Q000000981:diagnostic imaging; D001067:Appetite Depressants / Q000009:adverse effects*; D004338:Drug Combinations; D005260:Female; D005277:Fenfluramine / Q000009:adverse effects*; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000139:chemically induced / Q000150:complications; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D008944:Mitral Valve Insufficiency / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology; D010645:Phentermine / Q000009:adverse effects*; D014262:Tricuspid Valve Insufficiency / Q000139:chemically induced / Q000000981:diagnostic imaging; D014463:Ultrasonography
D001067:Appetite Depressants; D004338:Drug Combinations; D005277:Fenfluramine; D010645:Phentermine