Heart attacks linked to much-used drug

— The Scotsman, Wed 11 May 2005 —

IAN JOHNSTON, SCIENCE CORRESPONDENT

A DRUG used by thousands of Scots to treat heartburn and sickness dramatically increases the risk of dying from a sudden heart attack, according to new research.

More than 100,000 prescriptions for Domperidone are issued to Scots every year.

But yesterday Dutch scientists named the popular treatment among a group of drugs which result in 15,000 deaths annually in Europe and the United States.

The drugs, which include treatments for vertigo and brain disorders, have a potentially lethal side-effect that interferes with electrical activity controlling the heartbeat. The risk of sudden death was found to be “significantly increased” among people taking the medications, according to a report published in today’s edition of the European Heart Journal.

The new warning follows alerts over common arthritis drugs - called Cox-2 inhibitors - which have been linked to heart attacks and strokes.

The drugs involved in the Dutch research include three types of anti-psychotics - chlorpromazine, haloperidol and pimozide - which treat conditions such as schizophrenia. In Scotland more than 32,000 prescriptions were written for haloperidol last year.

The Dutch scientists studied 775 cases of sudden heart-attack deaths and found drugs that prolong the heart’s “QTc interval” - a measurement of electrical activity linked to the contraction of the heart - were probably responsible for about 40 per cent of them. One of the drugs involved, cisapride, was withdrawn from use in the UK in 2000.

The main author of the report, Dr Bruno Stricker from the Erasmus Medical Centre in Rotterdam, who is also a senior medical officer at the Inspectorate for Healthcare, said: “Our results suggest that 320 cases a year of sudden cardiac death can be attributed to QTc-prolonging medication in the Netherlands and, by extrapolation, around 9,000 in Europe and 6,000 in the USA.

“The risk of sudden cardiac death was higher among recent starters - within around 90 days - and was significantly increased in users of GI [gastro-intestinal] medication and anti-psychotics.”

It is normal to expect one or two sudden cardiac deaths per thousand of the population each year in Western countries, but the risk for people taking the drugs rose to around three per thousand, the study found.

However, despite this, Dr Stricker said: “These drugs are vital treatments for serious conditions in many cases, so it is essential that patients should not stop taking them on their own initiative.”

He cautioned that there were potential limitations to the study. Some misclassifications could not be excluded and a few deaths may have been missed. It was also possible that not all the deaths were heart-related.

However, Dr Stricker said these factors were unlikely to explain the strong association found between the drugs and sudden cardiac death.

A spokeswoman for the Medicines and Healthcare Products Regulatory Agency said it would examine the report and “consider what, if any, action is required”.

“Patients who are taking any of these medicines and are feeling well need not be concerned,” she said. “If a patient is feeling unwell or is concerned about their treatment then they should discuss their concerns with the doctor.”

Professor Peter Weissberg, medical director of the British Heart Foundation, warned patients to heed Dr Stricker’s advice to consult a doctor before changing their drug regime. “It is known that certain drugs change the heart rhythm by affecting potassium channels in the heart - indeed this is how some anti-arrhythmic drugs work,” he said.

Dr Dean Marshall, vice-chairman of the British Medical Association’s Scottish General Practitioners’ Committee, said: “It is important that patients do not stop taking any medication as a result of reading about this research without discussing their concerns with their doctor.

“In Scotland, drugs are subject to rigorous approval processes before they can be prescribed. Prior to taking a decision on treatment, doctors would consider the benefits and potential side-effects or risks associated with a particular drug.”

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