Drug-induced fibrotic valvular heart disease.

Full 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.

Author information

Author/s: Bhattacharyya, Sanjeev (S); Schapira, Anthony H (AH); Mikhailidis, Dimitri P (DP); Davar, Joseph (J);

Affiliation: Valvular Heart Disease Clinic, Department of Cardiology, Royal Free Hospital, London, UK.

Journal and publication information

Publication Type: Journal Article; Review

Journal: Lancet (Lancet), published in England. (Language: eng)

Reference: 2009-Aug; vol 374 (issue 9689) : pp 577-85

Dates: Created 2009/08/17; Completed 2009/08/27;

PMID: 19683643, status: MEDLINE (last retrieval date: 8/27/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Antiparkinson Agents - adverse effects
Appetite Depressants - adverse effects
Dexfenfluramine - adverse effects
Dopamine Agonists - adverse effects
Drug Monitoring
Ergolines - adverse effects
Ergotamine - adverse effects
Fenfluramine - adverse effects
Fibrosis
Heart Valve Diseases - chemically induced; diagnosis
Heart Valves - pathology

Associated Chemicals: Antiparkinson Agents (0) ; Appetite Depressants (0) ; Dopamine Agonists (0) ; Ergolines (0) ; Receptors, Serotonin (0) ; Serotonin Agents (0) ; Serotonin Plasma Membrane Transport Proteins (0) ; Vasoconstrictor Agents (0) ; Ergotamine (113-15-5) ; Dexfenfluramine (3239-44-9) ; Methysergide (361-37-5) ; N-Methyl-3,4-methylenedioxyamphetamine (42542-10-9) ; Fenfluramine (458-24-2) ; Pergolide (66104-22-1) ; cabergoline (81409-90-7)

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