Tegaserod-induced myocardial infarction: case report and hypothesis.
Serotonin (5-hydroxytryptamine [5-HT])1 receptor agonists, such as those used for treating migraine, can cause coronary artery contraction, coronary spasm, and even myocardial infarction. Tegaserod maleate is a relatively new 5-HT4 receptor agonist with moderate affinity for the 5-HT1 receptor. Currently, it is approved only for treatment of irritable bowel syndrome in women who have constipation as the primary symptom. However, it is also being administered as a promotility agent in patients with gastroparesis. Since tegaserod has affinity for the 5-HT1 receptor, it is plausible that tegaserod could cause the same types of cardiovascular adverse events seen with agents prescribed for management of migraine. We report the first case of a man who experienced a myocardial infarction after receiving only two 6-mg doses of tegaserod; we also provide a hypothesis regarding this event. When considering prescribing a drug with 5-HT1 receptor agonist activity, clinicians should review the patient's medical history specifically for the presence of underlying cardiovascular risk factors.
Busti
Anthony J
AJ
School of Pharmacy-Dallas/Ft. Worth Regional Campus, Texas Tech University Health Sciences Center, Dallas, Texas 75216, USA. anthony.busti@ttuhsc.edu
Murillo
Jose R
JR
Cryer
Byron
B
D048909:Diabetes Complications; D018589:Gastroparesis / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced*; D012307:Risk Factors; D017366:Serotonin Receptor Agonists / Q000009:adverse effects* / Q000627:therapeutic use
D007211:Indoles; D017366:Serotonin Receptor Agonists; C105050:tegaserod