Greater Awareness of Drugs Linked With PAH Could Improve Patient Outcomes

Increased clinician awareness of drugs that are linked with greater risk for development of pulmonary arterial hypertension (PAH) could lead to better diagnosis and treatment of PAH, according to a recently published study.

Using resources such as Pubmed, Google Scholar, and FDA websites, researchers conducted a literature review that included data from 1960 through 2016. The results of this review revealed that certain drugs are associated with PAH. These drugs are minorex, fenfluramine, dexfenfluramine, toxic rapeseed oil, selective serotonin reuptake inhibitors (SSRIs), and benfluorex, which is a derivative of fenfluramine. Other drugs were categorized as likely being tied to PAH, and these include amphetamines/methamphetamines, dasatinib, and L-tryptophan.
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Certain drugs have stronger associations with PAH than other drugs. Those with the strongest associations are methamphetamines, anorexic agents, and SSRIs. The effects of other drugs are more variable.

“The supposed mechanism is an increase in the serotonin levels or activation of serotonin receptors that has been demonstrated to act as a growth factor for the pulmonary artery smooth muscle cells and cause progressive obliteration of the pulmonary vasculature,” the researchers wrote.

The study’s authors noted that for several drugs, PAH is a rare complication, implying that an individual patient’s susceptibility might be responsible. The researchers suggest that clinicians make note of patients’ exposure to both recreational and prescription drugs during the evaluation of PAH. Greater awareness of the drugs a patient is taking might lead to quicker diagnosis of PAH, and the effects of PAH may potentially be reversed if the responsible drug is no longer used. However, the researchers stated that “further studies are needed to identify patients at risk of drug-induced PAH.”

—Lauren LeBano

Reference

Garg L, Akbar G, Agrawal S, et al. Drug-induced pulmonary arterial hypertension: a review. Heart Fail Rev. 2017. doi:10.1007/s10741-017-9612-9619.