Sibutramine-induced acute myocardial infarction in a young lady.
BACKGROUND
Sibutramine is an amphetamine-like drug used for its weight reducing effect. Sibutramine-induced acute coronary syndrome has rarely been reported. We report a case of myocardial infarction associated with the use of sibutramine.


METHODS
A 37-year-old woman presented to an Emergency Department (ED) with intermittent retrosternal chest pain, nausea, and sweating for 3 days. She reported taking one sibutramine tablet each day for 3 days. Blood pressure was 128/89 mm Hg and pulse 66 beats/min. An electrocardiogram revealed ST elevation over the inferior leads and ST depression over leads AVR and V1, the other leads were normal. Serum troponin T was 0.65 microg/L, and sibutramine was identified in her urine. Echocardiography revealed mild hypokinesia over the inferior wall without evidence of acute aortic dissection. The ST segment changes resolved spontaneously within 24 h of cardiac care unit (CCU) admission, a coronary angiogram performed 1 week later was unremarkable, and echocardiography performed 4 weeks after the event showed normal resting regional wall motion.


CONCLUSIONS
Seventeen medications containing sibutramine as an active ingredient were registered in Hong Kong in 2007. Sibutramine was introduced in the United States in 1997 and in Australia, United Kingdom, and Italy in 2001. Hypertension, tachycardia, dry mouth, and headache are the most commonly reported adverse reactions. Cardiovascular toxicities include tachycardia, palpitation, hypertension, and tachyarrhythmia.


CONCLUSIONS
We postulate that the myocardial infarction was the result of coronary vasospasm associated with the therapeutic use of sibutramine-containing slimming pills.
Yim
Kin-Ming Anfernee
KM
Hong Kong Poison Information Centre, United Christian Hospital, Hospital Authority, Hong Kong, China. anfernee_yim@hotmail.com
Ng
Hon Wah
HW
Chan
Chi-Kin
CK
Yip
Gabriel
G
Lau
Fei Lung
FL
D000328:Adult; D001067:Appetite Depressants / Q000009:adverse effects*; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced; D003503:Cyclobutanes / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D009203:Myocardial Infarction / Q000139:chemically induced*; D020107:Troponin T / Q000097:blood / Q000187:drug effects
D001067:Appetite Depressants; D003503:Cyclobutanes; D020107:Troponin T; C058254:sibutramine