Cerebral hemorrhage in a patient taking fenfluramine and phentermine for obesity
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Obesity affects approximately 58 million people in the United States and is the second leading cause of preventable death after cigarette smoking.1 Recently, the poor results of dietary and behavioral therapy for obesity have led to renewed interest in the use of appetite suppressants.1,2 One particularly popular regimen consists of the combination of sympathomimetic amines d,l-fenfluramine and phentermine. D,l-fenfluramine decreases appetite by stimulating serotonin release and inhibiting its reuptake by presynaptic neurons, whereas phentermine decreases appetite by modulating noradrenergic neurotransmission. Several studies suggest that the combination of d,l-fenfluramine and phentermine in low doses produces greater appetite suppression with fewer side effects than higher doses of individual drugs and may be a more effective treatment for obesity.2,3
Sympathomimetic amines such as amphetamines and phenylpropanolamine have a well-documented association with stroke and cerebral hemorrhage.4 Phentermine and d,l-fenfluramine have been associated with cases of cerebral infarction,5,6 but they have not been implicated as a cause …
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