Anorexogen-Related Cardiac Valvulopathy

TO THE EDITOR: In addition to those described by Howlin (1), additional errors in the editorial by St John Sutton (2) require correction. St John Sutton indicated that phentermine decreases appetite by inhibiting serotonin clearance in the lung. However, it is generally well accepted that the ability of phentermine to release the neurotransmitters norepinephrine and dopamine produces its anorectic effects (3). The incorrect notion that phentermine inhibits pulmonary clearance of serotonin first arose when Connolly and coworkers (4) apparently confused chlorphentermine, which does inhibit pulmonary serotonin clearance, with phentermine, which does not. Finally, the lack of valvular heart disease cases associated with the use of phentermine alone, and the fact that monotherapy with phentermine does not increase the risk for primary pulmonary hypertension (5), indicate that phentermine use does not cause these serious adverse effects.

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