Acute nonarteritic ischaemic optic neuropathy after phentermine

Abstract

Sir, Acute nonarteritic ischaemic optic neuropathy after phentermineAmphetamine derivatives used in weight reduction regimens are considered safe for use over a several week period. Ischaemic and/or haemorrhagic infarcts and necrotizing angiitis are common neurologic complications of amphetamine abuse. Ocular side effects of amphetamine abuse include mydriasis, decreased accommodation and convergence, visual hallucinations (blue tinge to objects), retinal vasoconstriction and vasculitis, retinal microaneurysms and haemorrhage, and anterior ischaemic optic neuropathy. 1 In this report a 35-year-old woman developed acute nonarteritic anterior ischaemic optic neuropathy (NAION) after two prescribed dosages of phentermine hydrochloride as part of her weight loss treatment. Case reportThis obese 35-year-old Caucasian woman developed an acute superior nasal visual field defect in her left eye 1 day after taking Adipex-P (phentermine hydrochloride) 37.5 mg p.o.q. day for 2 days. Her body mass index was 34 kg/m 2 . She had no history of heart disease, diabetes, hypertension, hypercholesterolaemia, or strokes.On neuro-ophthalmologic examination her visual acuity with correction was 20/20 OD and 20/100 OS. Humphrey visual fields revealed a left superior nasal focal defect respecting the horizontal meridian. She had a left relative afferent pupillary defect and a protan defect. Extraocular motility was normal. Slit-lamp examination revealed no cells or flare in the anterior chambers. On dilated funduscopic examination, her left optic disc appeared swollen with small slit-like peripapillary haemorrhages in the superior and temporal aspect of the disc. A small petechial haemorrhage was seen at the 5 o'clock position in the peripapillary region. No cotton wool spots were observed. Her right cup-to-disc ratio was 0.3. Maculae and peripheral retina were normal.MRI of the brain and orbits with gadolinium, MRA of the cerebral blood vessels, carotid ultrasound, and transoesophageal echocardiogram were all normal. Her cerebrospinal fluid (CSF) opening pressure was 148 mm H 2 O; CSF cell count, protein, glucose, VDRL, gram stain, bacterial, viral, and fungal cultures were all unremarkable. Leber's hereditary optic neuropathy mitochondrial DNA mutations for 3460, 11778, 14484, and 15257 alleles were all negative. Autoimmune profile including antinuclear antibody, double stranded DNA,

Branch retinal artery occlusion in a 49-year-Old woman taking phentermine

“… 3 , 4 , 5 These reports concluded that phentermine's sympathetic properties can cause vasoconstriction and vasospasm leading to ischemia in different organ systems. Chan 6 reported a 35-year-old woman who developed an acute non-arteritic anterior ischemic optic neuropathy (NAION) after taking two prescribed dosages of phentermine. Consequently, he concluded that the patient's vision loss was due to vasoconstriction of the posterior ciliary arteries secondary to phentermine use.…”

“… 1 , 2 While studies have shown that this drug is safe, several case reports have demonstrated phentermine being associated with adverse effects including stroke, myocardial infarction, and ischemic ocular diseases. 3 , 4 , 5 , 6 , 7 , 8 In addition, other amphetamine derivatives, especially ones that are abused like methamphetamine and cocaine, have been well documented to have harmful effects on the cardiovascular, neurologic, and psychologic systems. 9 In particular, ocular side effects of amphetamine abuse include mydriasis, decreased accommodation and convergence, visual hallucinations, retinal vasoconstriction and vasculitis, retinal microaneurysms and hemorrhage, and anterior ischemic optic neuropathy.…”

“… 9 In particular, ocular side effects of amphetamine abuse include mydriasis, decreased accommodation and convergence, visual hallucinations, retinal vasoconstriction and vasculitis, retinal microaneurysms and hemorrhage, and anterior ischemic optic neuropathy. 6 , 10 , 11 , 12 , 13 To date, there have been few studies reporting on the ocular effects of phentermine, especially on the retinal vasculature. Herein, we report a case of a patient with no significant past medical history presenting with a branch retinal artery occlusion (BRAO) after taking prescribed dosages of phentermine.…”

Recreational use of 3,4-methylenedioxymethamphetamine (‘ecstasy’) relieving symptoms of posterior scleritis

“…Amphetamine isomers have been described to induce acute nonarteritic ischaemic optic neuropathy. 2 Ecstasy also activates the hypothalamic pituitary adrenal axis, which induces a significant rise in cortisol plasma concentrations and a depression in immune function. [3][4][5] In summary, we present here a patient with long-standing, unrecognized posterior scleritis.…”