Dexfenfluramine

1. Note
   1. No longer available in United States
      1. Due to significant adverse effects (See below)
   2. Included for historical information only
2. Evaluating for adverse cardiac effects
   1. Careful history and exam
   2. Echocardiogram indications
      1. Symptoms suggestive of cardiopulmonary disease
      2. New onset murmur
      3. Consider for high patient anxiety
3. Dosage
   1. Dosing: 15 mg bid (Historical reference only)
4. Mechanism
   1. D-Isomer of d,I-fenfluramine (Pondimin)
   2. Was used in combination with Phentermine (Ionamin)
      1. Combination was known as "Phen-Fen"
5. Efficacy
   1. Obese patient over 6 months (n=822)
      1. Diet alone: 4.9 kg Weight Reduction
      2. Redux and Diet: 9.7 kg Weight Reduction
   2. Obese patients over 1 year (n=60)
      1. Diet alone: 7.2 kg Weight Reduction
      2. Redux and Diet: 9.8 kg Weight Reduction
   3. No difference from diet alone 5 months after treatment
6. Adverse Effects
   1. Drowsiness
   2. Diarrhea
   3. Dry Mouth
   4. Primary Pulmonary Hypertension
      1. Associated with use beyond 3 months
      2. Risk increased from 1 per Million to 18 per Million
      3. Obesity increases Pulmonary Hypertension risk 2 fold
   5. Valvular Heart Disease association
      1. New Heart Murmurs developed in 24 Phen-Fen Patients
         1. Mitral Regurgitation
         2. Aortic Insufficiency
         3. Tricuspid Regurgitation
      2. Occurred in women with over 1 year of Phen-Fen use
      3. References
         1. Connolly (1997) N Engl J Med, 337(9): 581-8