| Title | Drug-induced fibrotic valvular heart disease. | | Author(s) | Bhattacharyya S, Schapira AH, Mikhailidis DP, Davar J | | Institution | Valvular Heart Disease Clinic, Department of Cardiology, Royal Free Hospital, London, UK. | | Source | Lancet 2009 Aug 15; 374(9689):577-85. | | MeSH | Antiparkinson Agents
Appetite Depressants
Dexfenfluramine
Dopamine Agonists
Drug Monitoring
Ergolines
Ergotamine
Fenfluramine
Fibrosis
Heart Valve Diseases
Heart Valves
Humans
Methysergide
Migraine Disorders
N-Methyl-3,4-methylenedioxyamphetamine
Patient Selection
Pergolide
Receptors, Serotonin
Serotonin Agents
Serotonin Plasma Membrane Transport Proteins
Vasoconstrictor Agents
| | 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. | | Language | eng | | Pub Type(s) | Journal Article
Review
| | PubMed ID | 19683643 |
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