Benfluorex, sold under the brand name Mediator, is an anorectic and hypolipidemic agent that is structurally related to fenfluramine (a substituted amphetamine). It may improve glycemic control and decrease insulin resistance in people with poorly controlled type-2 diabetes.
|AHFS/Drugs.com||International Drug Names|
|CompTox Dashboard (EPA)|
|ECHA InfoCard||100.041.601 |
|Chemical and physical data|
|Molar mass||351.363 g/mol g·mol−1|
|3D model (JSmol)|
It was on the market between 1976 and 2009, and is thought to have caused between 500 and 2,000 deaths. It was patented and manufactured by the French pharmaceutical company Servier. However, Servier is suspected of having marketed benfluorex at odds with the drug's medical properties.
On 18 December 2009, the European Medicines Agency recommended the withdrawal of all medicines containing benfluorex in the European Union, because their risks, particularly the risk of heart valve disease (fenfluramine-like cardiovascular side effects), are greater than their benefits. Thus Frachon et al. showed a higher rate of unexplained valvular heart disease in people taking benfluorex. Weill et al. looked at over 1 million people with diabetes demonstrating a higher hospitalization rate in benfluorex takers for valvular heart disease.
In France, the medication had been marketed as by Servier as an adjuvant antidiabetic under the name Mediator. The drug was on the market between 1976 and 2009, and is thought to have caused between 500 and 2,000 deaths. The drug was also used in Spain, Portugal, and Cyprus.
Fenfluramine, a related drug, had been withdrawn from the market in 1997 after reports of heart valve disease, pulmonary hypertension, and development of cardiac fibrosis. This side effect is mediated by the metabolite norfenfluramine on 5HT2B receptors of heart valves, leading to a characteristic pattern of heart failure following proliferation of cardiac fibroblasts on the tricuspid valve. Both fenfluramine and benfluorex form norfenfluramine as a metabolite. This side effect led to the withdrawal of fenfluramine as an anorectic drug worldwide, and later to the withdrawal of benfluorex in Europe.
- Moulin P, Andre M, Alawi H, dos Santos LC, Khalid AK, Koev D, et al. (March 2006). "Efficacy of benfluorex in combination with sulfonylurea in type 2 diabetic patients: an 18-week, randomized, double-blind study". Diabetes Care. 29 (3): 515–20. doi:10.2337/diacare.29.03.06.dc05-1439. PMID 16505498.
- Roger P, Auclair J, Drain P (1999). "Addition of benfluorex to biguanide improves glycemic control in obese non-insulin-dependent diabetes: a double-blind study versus placebo". Journal of Diabetes and Its Complications. 13 (2): 62–7. doi:10.1016/S1056-8727(98)00004-X. PMID 10432168.
- "France braced for diabetic drug scandal report". BBC News. 2011-01-11.
- Mullard A (March 2011). "Mediator scandal rocks French medical community". Lancet. 377 (9769): 890–2. doi:10.1016/s0140-6736(11)60334-6. PMID 21409784.
- "European Medicines Agency recommends withdrawal of benfluorex from the market in European Union" (PDF). European Medicines Agency. 2009-12-18. Archived from the original (PDF) on 2009-12-22. Retrieved 2015-01-12.
- Frachon I, Etienne Y, Jobic Y, Le Gal G, Humbert M, Leroyer C (April 2010). Lexchin J (ed.). "Benfluorex and unexplained valvular heart disease: a case-control study". PLOS ONE. 5 (4): e10128. Bibcode:2010PLoSO...510128F. doi:10.1371/journal.pone.0010128. PMC 2853566. PMID 20405030.
- Weill A, Païta M, Tuppin P, Fagot JP, Neumann A, Simon D, et al. (December 2010). "Benfluorex and valvular heart disease: a cohort study of a million people with diabetes mellitus". Pharmacoepidemiology and Drug Safety. 19 (12): 1256–62. doi:10.1002/pds.2044. PMID 20945504.
- Connolly HM, Crary JL, McGoon MD, Hensrud DD, Edwards BS, Edwards WD, Schaff HV (August 1997). "Valvular heart disease associated with fenfluramine-phentermine". The New England Journal of Medicine. 337 (9): 581–8. doi:10.1056/NEJM199708283370901. PMID 9271479.
- Weissman NJ (April 2001). "Appetite suppressants and valvular heart disease". The American Journal of the Medical Sciences. 321 (4): 285–91. doi:10.1097/00000441-200104000-00008. PMID 11307869.
- Rothman RB, Baumann MH, Savage JE, Rauser L, McBride A, Hufeisen SJ, Roth BL (December 2000). "Evidence for possible involvement of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications". Circulation. 102 (23): 2836–41. doi:10.1161/01.cir.102.23.2836. PMID 11104741.