Sibutramine-induced acute myocardial infarction in a young lady

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 46; no. 9; pp. 877 - 879
• Main Authors: Yim, Kin-Ming Anfernee, Ng, Hon Wah, Chan, Chi-Kin, Yip, Gabriel, Lau, Fei Lung
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Informa UK Ltd 01-11-2008; Taylor & Francis
• Subjects: Adult; Appetite Depressants - adverse effects; Biological and medical sciences; Cardiology. Vascular system; Coronary Angiography; Coronary heart disease; Coronary Vasospasm - chemically induced; Cyclobutanes - adverse effects; Drug toxicity and drugs side effects treatment; Electrocardiography; Female; Follow-Up Studies; Heart; Hong Kong; Humans; Medical sciences; Myocardial Infarction - chemically induced; Myocarditis. Cardiomyopathies; Pharmacology. Drug treatments; Toxicity: cardiovascular system; Troponin T - blood; Troponin T - drug effects; Hong Kong; Human; Myocardial infarction; Serotonin; Toxicity; Acute; Cardiovascular disease; Sibutramine; Catecholamine; Reuptake inhibitor; Coronary vessel; Myocardial disease; Coronary heart disease; Case study; Neurotransmitter; Spasm; Coronary spasm; Norepinephrine; Anorectic; Acute myocardial infarction
• ISSN: 1556-3650; 1556-9519
• DOI: 10.1080/15563650802136258

Introduction. Sibutramine is an amphetamine-like drug used for its weight reducing effect. Sibutramine-induced acute coronary syndrome has rarely been reported. We report a case of myocardial infarction associated with the use of sibutramine. Case Report. A 37-year-old woman presented to an Emergency Department (ED) with intermittent retrosternal chest pain, nausea, and sweating for 3 days. She reported taking one sibutramine tablet each day for 3 days. Blood pressure was 128 89 mm Hg and pulse 66 beats min. An electrocardiogram revealed ST elevation over the inferior leads and ST depression over leads AVR and V1, the other leads were normal. Serum troponin T was 0.65 μg L, and sibutramine was identified in her urine. Echocardiography revealed mild hypokinesia over the inferior wall without evidence of acute aortic dissection. The ST segment changes resolved spontaneously within 24 h of cardiac care unit (CCU) admission, a coronary angiogram performed 1 week later was unremarkable, and echocardiography performed 4 weeks after the event showed normal resting regional wall motion. Discussion. Seventeen medications containing sibutramine as an active ingredient were registered in Hong Kong in 2007. Sibutramine was introduced in the United States in 1997 and in Australia, United Kingdom, and Italy in 2001. Hypertension, tachycardia, dry mouth, and headache are the most commonly reported adverse reactions. Cardiovascular toxicities include tachycardia, palpitation, hypertension, and tachyarrhythmia. Conclusions. We postulate that the myocardial infarction was the result of coronary vasospasm associated with the therapeutic use of sibutramine-containing slimming pills.