Tejaswi Makkapati, MD
Resident Physician
HMH/JFK Johnson Rehabilitation Institute
Edison, New Jersey, United States
Matthew Moore, DO
Physician
HMH/JFK Johnson Rehabilitation Institute
Edison, New Jersey, United States
Christine Greiss, DO
Physician
HMH/JFK Johnson Rehabilitation Institute
Edison, New Jersey, United States
Phentermine exacerbated basal ganglia hemorrhage in a 40 yo woman
Case Description: 40 yo mildly overweight woman with no significant medical history presented with headache, vomiting and speech deficits, and progressed to being obtunded hours later. She was found to have a left basal ganglia hemorrhage with IVH while taking phentermine for weight loss. Patient took phentermine for one month prior to injury. Hospital course was complicated by obstructive hydrocephalus and she received intrathecal tPA. Digital subtraction angiography showed an aneurysm in the anterior communicating artery and a small AVM. Patient was stabilized and transferred to IRF. Her rehabilitation course was complicated by hypotension, vertigo, and visual deficits. Repeat imaging showed an evolving basal ganglia infarct with edema. Medical management was initiated for symptom management.
Discussions: Phentermine has been the most frequently prescribed drug in the antiobesity medication category in the last 20 years with some estimating 0.5% to 0.7% of the U.S. population may be taking it. The average length of use is approximately 81 days. Phentermine is a sympathomimetic stimulant which is thought to cause norepinephrine release from the hypothalamus. It was originally prescribed with fenfluramine, with reports of ischemic and hemorrhagic strokes in the 1990s, during which fenfluramine was removed from the market due to its association with cardiac valvulopathy. Phentermine’s classically associated side effect is hypertension. This patient did not have hypertension prior to starting this drug. While she was found to have an aneurysm and AVM, the timing of this patient’s ICH with recent initiation of phentermine in a patient who was mildly overweight may shed light on common practice patterns and medication prescribing that can have unintended outcomes.
Conclusions: We describe a unique case of phentermine exacerbated basal ganglia hemorrhage. Recognizing this complication is important for clinicians as weight loss medications continue to gain popularity.
