Last week the Food and Drug Administration asked the manufacturers of the popular diet drugs fenfluramine and Redux to withdraw their products, citing "an unacceptable risk" of heart valve problems. The agency also advised consumers to stop taking the drugs and to contact their doctors.
Users of fen-phen (a combination of fenfluramine, sold as Pondimin, and the drug phentermine) and Redux faced many unanswered questions. Among them:
Question: Which is better, to taper off or to quit these drugs cold turkey?
Answer: "I think it's better to taper off over a week or so," says Dr. Richard L. Atkinson, professor of medicine and nutritional sciences at the University of Wisconsin, Madison, and president of the American Obesity Assn. But he hastens to add: If you've already quit cold turkey, don't start up again.
Adds Dr. Morton Maxwell, clinical professor of medicine and director of the University Obesity Center at the UCLA School of Medicine: "In the literature, it has been reported that in some patients after stopping fenfluramine [abruptly] they can become mildly depressed for a week or so." But, he says, many patients in the UCLA program, for example, have forgotten to bring the drug on vacation with them and have not had serious problems.
Q: What kind of physical exam and other tests do I need?
A: Your doctor should take a thorough medical history and conduct a physical with an emphasis on examining the heart and lungs, says Dr. Richard Kerber, professor of medicine and director of the echocardiography lab at the University of Iowa, Iowa City, and president of the American Society of Echocardiography.
Your doctor should listen to your heart with a stethoscope as you lie down, bend over and possibly assume other positions, says Kerber.
If there is any suspicion of heart valve problems, your physician should order an echocardiogram, a diagnostic procedure that uses high-frequency sound waves, or ultrasound, to take moving pictures of the heart.
If your doctor does not think an echocardiogram is needed, you should return for follow-up exams at intervals to be decided based on medical history and other factors, says Atkinson.
Q: If there is heart valve damage, won't I have symptoms?
