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Pulmonary arterial hypertension: sometimes drug-induced

Many drugs can cause pulmonary arterial hypertension, which sometimes improves when treatment is halted.

Pulmonary arterial hypertension is a disease of the lungs, characterised by shortness of breath on exertion and then at rest, gradually progressing to heart failure and even death. This disease is sometimes caused by a drug.

Amphetamines used as appetite suppressants have been associated with pulmonary arterial hypertension since the late 1960s. Several epidemiological studies have confirmed the role of fenfluramine and dexfenfluramine, and implicated many other amphetamines. In 2016, 1,273 observations of pulmonary arterial hypertension attributed to benfluorex were reported to the French Health Products Agency.

The number of drugs known to provoke pulmonary arterial hypertension has increased over the years. These include anti-tumour treatments such as dasatinib or related drugs, immunosuppressants such as leflunomide or omalizumab and various other drugs such as interferons or sofosbuvir.

The disorders sometimes improve with withdrawal from the drug responsible. When pulmonary arterial hypertension is suspected to be the cause of respiratory disorders, it can be of great help to patients to consider the possibility that it was induced by a drug.

©Prescrire 1 July 2020

Source: "Drug-induced pulmonary arterial hypertension" Prescrire International 2020; 29 (217): 180-183. Subscribers only.

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