[32-year-old patient with acute myocardial infarction possibly induced by the appetite suppressant sibutramine]

Cardiogenic shock in a 28-year-old woman associated with sibutramine use

A 28-year-old woman collapsed in her home, and her companion rushed to call emergency services. Upon arrival, a physician performed CPR and endotracheal intubation, successfully restoring her voluntary heart rhythm. However, while en route to the hospital, ventricular fibrillation recurred. Despite the restoration of her voluntary rhythm through electrical defibrillation, she remained in a comatose state, which eventually led to multiple organ failures. Family members revealed that she had a 2-month history of taking diet pills. Histological examination revealed cardiomyocyte necrosis, contraction band necrosis, interstitial hemorrhage, collagen deposition, interstitial fiber proliferation, and myofiber remodeling. Analysis of blood and urine using GC-MS and LC-MS detected sibutramine and its primary metabolites, M1 and M2, which were consistent with the composition of the medication she was taking. The deceased was in good health with no underlying heart disease. The above information confirmed that the cause of her death was sibutramine.

Sibutramine as a Cause of Sudden Cardiac Death

Importance. Sibutramine was withdrawn from the US market due to association with adverse cardiovascular outcomes especially with patients having preexisting cardiac disease. However, continued presence of sibutramine in herbal medications is a concern to public safety. Results. We report a case of a patient with no evidence of previous coronary heart disease, who presented with non-ST elevation acute coronary syndrome (NSTE-ACS). Urgent coronary catheterization showed nonobstructive coronaries. However, patient died unexpectedly within 24 hours of admission. The patient denied toxic habits but was taking over-the-counter weight loss herbal supplements. Complete autopsy was performed which showed sibutramine in the toxicology. Patient died due to complications of acute inadvertent intoxication of sibutramine. Conclusion and Relevance. This is the first case report in literature showing association of sibutramine to sudden cardiac death in patients with no prior cardiac history. The continued presence of sibutramine in some over-the-counter weight loss formulations is a very concerning public health issue.

A case of dilated cardiomyopathy with massive left ventricular thrombus after use of a sibutramine-containing slimming product

Sibutramine, which acts as an anti-obesity drug by inhibiting reuptake of serotonin and norepinephrine, has now been banned due to cardiovascular adverse effects. However, despite being banned, it is not uncommon for people to purchase products with sibutramine or its analogues used as adulterants in non-prescription slimming products or health foods available on the internet. Sibutramine has been associated with rare but serious adverse reactions such as cardiac arrhythmia including QT interval prolongation, myocardial infarction, and cardiomyopathy, as well as increases in blood pressure and pulse rate. Here, we report a case of a 32-year-old male who presented with dilated cardiomyopathy with massive left ventricular thrombus after taking unauthorized sibutramine-containing slimming pills sold over the internet.

Two Fatalities Associated with Sibutramine

Sibutramine is an amphetamine derivative that has been prescribed as an antidepressant and appetite suppressant. It was voluntarily removed from the U.S. market in 2010 following a clinical trial that showed an increased risk of stroke and myocardial infarction. It has been detected as a clandestine additive in some over-the-counter weight loss and herbal remedies available on the Internet and in retail stores. We describe two fatalities involving the non-prescribed use of sibutramine by women using over-the-counter, herbal, weight loss supplements. Physicians need to be aware of inadvertent ingestion of sibutramine by patients who take herbal remedies for weight loss. Medical examiners and coroners may consider further investigation of sudden deaths in people who are taking herbal remedies for weight loss even with a history of heart disease. Since routine toxicology screens may not detect sibutramine, the toxicology laboratory should be informed when sibutramine is suspected.