[Appetite suppressants and heart valve disorders].
Serotoninergic appetite-suppressant drugs, fenfluramine and dexfenfluramine, were withdrawn from the market in September 1997 on account of two major cardiopulmonary complications: primary pulmonary hypertension and valvular regurgitation. The valvular heart diseases involve mainly left-sided valves, and contrary to physiological valvular regurgitations, they appear mostly on the aortic valve. Prolonged exposure (> 3 months) appears to confer a higher risk of cardiac valve involvement. Pathological features are similar to carcinoid or ergot alkaloid-induced valve diseases, and suggest a common pathophysiological mechanism which would also explain pulmonary hypertension by the toxic effect of high levels of circulating serotonin. After the first reports documenting a dramatically high prevalence of valvular side effects (up to 33% according to the Food and Drug Administration), recent studies reported a lower prevalence and severity. The long-term outcome and the real incidence are unknown and require further research and epidemiological data. A clinical survey of the patients exposed to serotoninergic appetite-suppressants is necessary, to be repeated 6 to 8 months later in the absence of an initial cardiac murmur. Doppler echocardiographic examination should be performed after prolonged exposure (> 3 months) or a high dosage of these drugs, in circumstances such as the presence of cardiovascular symptoms, a cardiac murmur, or an uncertain cardiac examination because of weight of patients.
Adams
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C
Service de cardiologie, centre hospitalier Victor Dupouy, Argenteuil.
Cohen
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A
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000139:chemically induced / Q000517:prevention & control; D001067:Appetite Depressants / Q000009:adverse effects*; D020372:Dexfenfluramine / Q000009:adverse effects; D005260:Female; D005277:Fenfluramine / Q000009:adverse effects; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D006976:Hypertension, Pulmonary / Q000139:chemically induced* / Q000517:prevention & control; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000139:chemically induced / Q000517:prevention & control; D010645:Phentermine / Q000009:adverse effects; D011665:Pulmonary Valve Insufficiency / Q000139:chemically induced / Q000517:prevention & control; D018490:Serotonin Agents / Q000009:adverse effects*; D017366:Serotonin Receptor Agonists / Q000009:adverse effects*
D001067:Appetite Depressants; D018490:Serotonin Agents; D017366:Serotonin Receptor Agonists; D005277:Fenfluramine; D010645:Phentermine; D020372:Dexfenfluramine