Valvular heart disease associated with fenfluramine-phentermine
Valvular heart disease associated with fenfluramine-phentermine
复制标题
DOI：
10.1056/nejm199708283370901
复制
发表时间：
1997-08-28
影响因子：
158.5
通讯作者：
Schaff, HV
中科院分区：
文献类型：
--
作者：
Connolly, HM;Crary, JL;Schaff, HV
芬氟拉明和芬特明已被美国食品和药物管理局（FDA）单独批准为厌食剂。当联合使用时，这些药物可能与单独使用任何一种药物一样有效，同时还具有需要更低剂量的每种药物和更少副作用的额外优势。虽然组合还没有被FDA批准，在1996年的处方总数在美国芬氟拉明和芬特明超过18 million.Methods我们确定了心脏瓣膜病在24名妇女治疗芬氟拉明，芬特明谁没有心脏病史。这些妇女表现出心血管症状或心脏杂音。随着越来越多的这些患者具有相似的临床特征被确定，似乎是这些功能和芬氟拉明，芬特明therapy.Results 24名妇女（平均[+/-SD]年龄，44+/-8岁）之间的关联进行了评估12.3+/-7.1个月后开始芬氟拉明，芬特明治疗。超声心动图显示所有患者的瓣膜形态异常和返流。右侧和左侧心脏瓣膜均受累。8名妇女还新记录肺动脉高压。迄今为止，已有5名患者需要心脏外科手术干预。心脏瓣膜呈白色光泽。组织学发现包括瓣叶和腱索结构的斑块样包绕，瓣膜结构完整。的组织病理学特征是相同的，在类癌或麦角胺引起的瓣膜diseases.Conclusions这些情况下引起关注，芬氟拉明，芬特明治疗可能与心脏瓣膜病。应告知芬氟拉明-芬特明治疗的候选人严重的潜在不良反应，包括肺动脉高压和心脏瓣膜病。(C)1997年，马萨诸塞州医学会。
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. (C) 1997, Massachusetts Medical Society.