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Diet drug combo may cause problems during surgery
November 4, 1996
Web posted at: 5:00 p.m.From Correspondent Elizabeth Cohen
(CNN) -- During surgery, the last thing an anesthesiologist wants is for the patient's blood pressure to plummet. But that is exactly what has happened to some patients who've been on the diet treatment fen-phen.
Fen-phen is actually a combination of two drugs, phentermine and fenfluramine, sold as pondimin. Anesthesiologists think fenfluramine may reduce the amount of norepinephrine in the body. Norepinephrine is a chemical that helps lower blood pressure. When blood pressure goes too low for too long, a patient can have a heart attack or a stroke.
Anesthesiologists can usually increase a patient's blood pressure with a drug called ephedrine. But in Tyler, Texas, things were different during recent surgeries on two patients who had taken fen-phen. Several doses of ephedrine failed to raise the patients' blood pressure. Anesthesiologists had to take the unusual step of injecting norepinephrine directly into the patients.
"It's been several years since I've had to give it," said Dr. Asa Lockhart, one of the participating anesthesiologists. "It's not a normal occurrence at all."
Now hospitals in Tyler have a rule: Unless it's an emergency, patients have to be taken off fen-phen for two weeks before doctors will operate.
Other hospitals, like Cedars-Sinai in Los Angeles, have instituted similar rules. But doctors cannot delay surgery if their patients don't reveal that they're on fen-phen. As Patty Gentry, a registered nurse, explains, "A lot of (patients) just don't really believe it's a medication, and other patients are just embarrassed by the fact that they're taking medications to reduce their weight."
Neither Wyaeth-Ayerst, which makes fenfluramine, nor the U.S. Food and Drug Administration, would agree to an on-camera interview with CNN. But both said there has been only one reported case of a patient on phen-fen having problems during surgery. The FDA has informed doctors about the patient, who, 19 years ago, had been taking fenfluramine, and went into cardiac arrest under anesthesia.
No one can be absolutely sure that it's fen-phen that causes blood pressure to decrease. But the American Society of Anesthesiologists has issued a statement saying its members are concerned about reports that some patients taking fen-phen are experiencing "adverse and potentially deadly reactions while under general anesthesia."
Of course, the majority of patients taking fen-phen have no problems during surgery, and some anesthesiologists see no reasons to delay operations. But others are more cautious, pointing out that there have been no scientific studies regarding the effect of fenfluramine on anesthesia. These doctors, ultimately, are taking no chances.
Related story:
- Experts: Powerful diet drug can be deadly - October 9, 1996
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