HEART  ATTACK   Induced by AppetiteSuppressants

During the past 10 years, there has been a precipitous rise in the number of reports of adverse drug reactions in Malaysia.¹ Of these reports, 20 have involved antiobesity medications, of which only phentermine and orlistat are legally available. Sibutramine, whose approval has been withheld owing to reports of adverse reactions, has been available through the black market.²

The use of the appetite suppressant phenylpropanolamine has been associated with myocardial infarction( Heart attack ) in patients with angiographically normal coronary arteries. To date, no similar data have been reported with regard to phentermine or sibutramine. We report on two otherwise healthy young women who had myocardial infarction with acute ST-segment elevation associated with the use of phentermine and sibutramine.

Patient 1 was a 35-year-old woman in whom acute ST-segment elevation  and hypotension developed after the induction of general anesthesia for liposuction. Cardiac biomarkers were elevated (creatine kinase level, 445 U per liter; troponin T level, 1.86 �g per liter). Echocardiography revealed septal hypokinesia. The coronary arteries appeared normal on angiography.

Patient 2 was an otherwise healthy 24-year-old woman who presented to the emergency room with severe, recurrent retrosternal chest pains. Electrocardiography showed acute inferior myocardial infarction . Peak levels of serum creatine kinase and troponin T were 3450 U per liter and 4.25 �g per liter, respectively. The results of coronary angiography were normal. She had no other medical illnesses, was not taking any medications, and was a nonsmoker. She reported having taken sibutramine for the previous 3 months.

1. Annual report of the Malaysian Adverse Drug Reactions Advisory Committee 2005. Kuala Lumpur, Malaysia: National Pharmaceutical Control Bureau, Ministry of Health, 2005.