Diet Pill Redux

By Christine Gorman

Two years ago, you could hardly pick up a newspaper or a magazine (including this one) without catching the buzz about a pill called Redux that was going to revolutionize the way Americans lose weight. Then last summer doctors noticed an alarming number of heart-valve problems in their patients who took Redux or its chemical cousin fenfluramine, prompting the recall of both drugs. Now comes word, from three studies published in last week's New England Journal of Medicine, that the heart problems may not be as serious as was first feared--at least for patients who took the pills for less than three months.

Just how relieved you feel, however, depends on how carefully you read the reports. Taken together, the studies do, after all, confirm that taking Redux or fenfluramine (whether alone or in combination with phentermine as part of the wildly popular fen/phen regimen) can trigger an abnormal thickening of the heart valves, which may cause a backward flow and pooling of blood. Cardiologists pay special attention to such "leaky valves" because they are particularly vulnerable to infection, may predispose you to congestive heart failure or may signal the need for surgery.

Under the best circumstances--in which patients took Redux at the recommended dose for the shortest period of time, 11 weeks--changes in heart valves appeared to be not too serious. The longer that patients took the diet pills or the higher the dose, however, the greater the problems. (In the case of Redux, that meant taking more than 30 mg a day; for fenfluramine, more than 60 mg a day.) One study found that the risk of developing a heart-valve problem jumped 10- to 20-fold.

There are some unanswered questions. "We need to find out if those valves heal," says Dr. Ann Bolger, a cardiologist and spokeswoman for the American Heart Association. "There have been isolated reports of people getting better after they stopped taking the drugs. But we really don't know." She predicts it will take an additional six to 12 months of research to find out.

In the meantime, if you took Redux or fenfluramine, be sure to tell your doctor. If he or she detects a murmur or if you develop significant shortness of breath, you will have to have an ultrasound examination of the heart called an echocardiogram to determine whether you need further medical attention. If there is a valve problem, you may have to take antibiotics before undergoing certain procedures, such as teeth cleaning, that increase the risk that bacteria could enter your bloodstream.

One good thing that has come out of all this is that doctors and patients seem more realistic about another diet pill, Meridia, which was approved after Redux was recalled. Most see it as part of a diet-and-exercise program instead of a one-pill panacea. And physicians are more likely to restrict its use to the truly obese.

Still, not everyone has got the message. Some doctors are now prescribing the anti-depressant Prozac with phentermine for weight loss. Just remember, this combination, like fen/phen before it, has never been approved by the Food and Drug Administration. You could wind up losing your health along with the pounds.

See time.com/personal for sound advice on losing weight. For more information on heart-valve conditions, see amhrt.org