Fenfluramine
A drug used as an appetite suppressant
Fenfluramine is a drug that was primarily used as an appetite suppressant in the treatment of obesity. It is a serotonin releasing agent and was part of the anti-obesity medication combination known as fen-phen. Fenfluramine was withdrawn from the market in 1997 due to concerns about its association with cardiac valvulopathy and pulmonary hypertension.
Pharmacology
Fenfluramine acts by increasing the levels of serotonin, a neurotransmitter that regulates mood, appetite, and other functions. It does this by promoting the release of serotonin from neurons and inhibiting its reuptake, leading to increased serotonin activity in the brain. This action on serotonin is believed to contribute to its appetite-suppressing effects.
Medical uses
Fenfluramine was used as an appetite suppressant to aid in weight loss for individuals with obesity. It was often prescribed in combination with phentermine, another appetite suppressant, in the fen-phen combination. This combination was found to be effective in promoting weight loss but was later linked to serious side effects.
Adverse effects
The use of fenfluramine was associated with several adverse effects, the most significant being its impact on the heart. It was found to cause valvular heart disease and pulmonary hypertension, conditions that led to its withdrawal from the market. Other side effects included dizziness, dry mouth, insomnia, and nervousness.
Withdrawal from the market
In 1997, fenfluramine was withdrawn from the market by its manufacturer, following reports of heart valve disease and pulmonary hypertension in patients who had taken the drug. The decision to withdraw fenfluramine was based on findings from the Food and Drug Administration (FDA) and other health authorities that linked the drug to these serious health risks.
Current status
Although fenfluramine was withdrawn from the market for its use in obesity, it has been repurposed for other medical conditions. In 2020, a low-dose formulation of fenfluramine was approved by the FDA for the treatment of Dravet syndrome, a rare form of epilepsy. This approval was based on clinical trials that demonstrated its efficacy in reducing the frequency of seizures in patients with this condition.
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Contributors: Prab R. Tumpati, MD