Cardiology Medical News about drug-induced fibrotic valvular heart disease, serotonergic pathways

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Drug-induced fibrotic valvular heart disease
The Lancet, 08/19/09

Bhattacharyya S et al. – A review of drug-induced fibrotic valvular heart disease summarizes the results of recent clinical trials, natural history, and potential mechanisms. Further study is needed to guide with treatment decisions. Continued vigilance is critical as several common treatments interact with serotonergic pathways. Physicians must balance benefits of continued therapy against possible risks.

Methods

Review of drug-induced fibrotic valvular heart disease

Results

Initial association between development of valvular heart disease and drugs based on 1960s use of methysergide and ergotamine for migraine prophylaxis
Currently implicated are the appetite suppressants fenfluramine and dexfenfluramine, the dopamine agonists pergolide and cabergoline, and the recreational drug ecstasy (MDMA)
Clinical trials results: drug dose and treatment duration affect both risk of developing disease and its severity
Natural history remains unclear; reported regression of valvular lesions after treatment ends
Likely mechanism for development of drug-induced valvular heart disease: interference with serotonin metabolism and its associated receptors and transporter gene

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