Drug-induced fibrotic valvular heart disease.
Sanjeev Bhattacharyya, Anthony H Schapira, Dimitri P Mikhailidis, Joseph Davar
The Lancet August 15, 2009 DOI: 10.1016/s0140-6736(09)60252-x (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Interventions | Methysergide Ergotamine Fenfluramine Dexfenfluramine Pergolide Cabergoline Ecstasy (3 4-methylenedioxymethamphetamine; MDMA) |
| Key findings | The review reports that several drugs, including methysergide, ergotamine, fenfluramine, dexfenfluramine, pergolide, cabergoline, and ecstasy (MDMA), have been linked to valvular heart disease. Clinical trial results indicate that higher drug dose and longer treatment duration increase both the risk and severity of the disease, and regression of valvular lesions after treatment ends has been reported. The author proposes that interference with serotonin metabolism and its associated receptors and transporter gene is a likely mechanism. |
Abstract
The initial association between the development of valvular heart disease and drugs stems from observations made during the use of methysergide and ergotamine for migraine prophylaxis in the 1960s. Since then, the appetite suppressants fenfluramine and dexfenfluramine, the dopamine agonists pergolide and cabergoline, and more recently, the recreational drug ecstasy (3,4 methylenedioxymethamphetamine; MDMA) have been implicated. Results from clinical trials show that drug dose and treatment duration affect both the risk of developing the disease and its severity. The natural history of the disease remains unclear, although regression of valvular lesions after the end of treatment has been reported. Interference with serotonin metabolism and its associated receptors and transporter gene seems a likely mechanism for development of the drug-induced valvular heart disease. Physicians need to balance the benefits of continued therapy with these drugs against possible risks. Further investigation is needed to assist with treatment decisions. Continued vigilance is necessary because several commonly prescribed treatments interact with serotonergic pathways.
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- A Clinical Plan for MDMA (Ecstasy) in the Treatment of Posttraumatic Stress Disorder (PTSD): Partnering with the FDA Journal of Psychoactive Drugs June 1, 2002
- 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") induces fenfluramine-like proliferative actions on human cardiac valvular interstitial cells in vitro. Molecular Pharmacology June 2003