Work

Serotonergic drugs and valvular heart disease

Year: 2009

Type: article

Abstract: BACKGROUND: The serotonin (5-HT) releasers (+/-)-fenfluramine and (+)-fenfluramine were withdrawn from clinical use owing to increased risk of valvular heart disease. One prevailing hypothesis (i.e., the '5-HT hypothesis') suggests that fenfluramine-induced increases in plasma 5-HT underlie the disease. OBJECTIVE: Here, we critically evaluate the possible mechanisms responsible for fenfluramine-associated valve disease. METHODS: Findings from in vitro and in vivo experiments performed in our laboratory are reviewed. The data are integrated with existing literature to address the validity of the 5-HT hypothesis and suggest alternative explanations. CONCLUSIONS: The overwhelming majority of evidence refutes the 5-HT hypothesis. A more likely cause of fenfluramine-induced valvulopathy is activation of 5-HT(2B) receptors on heart valves by the metabolite norfenfluramine. Future serotonergic medications should be designed to lack 5-HT(2B) agonist activity.

Source: Expert Opinion on Drug Safety

DOI: 10.1517/14740330902931524

Authors: Richard B Rothman, Michael H Baumann

Institutions: National Institutes of Health, National Institute on Drug Abuse

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: National Institutes of Health, National Institute on Drug Abuse