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Una D. McCann, MD
National Institute of Mental Health Bethesda, Md

Lewis S. Seiden, PhD
University of Chicago Chicago, Ill

Lewis J. Rubin, MD
University of Maryland School of Medicine

George A. Ricaurte, MD, PhD
Johns Hopkins University School of Medicine Baltimore, Md

JAMA. 1997;278(24):2142.

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In Reply.

—Dr Lipetz presents intriguing evidence for differences in the Trp/LNAA ratios of fenfluramine and dexfenfluramine users vs control dieters that, at least in part, may be related to the serotonergic neurotoxic effects of fenfluramine(s). The basis for the sex differences and his suggestion that tolerance to the anorectic effects of fenfluramine(s) may be related to the loss of brain serotonin terminals both merit further exploration. As we have discussed elsewhere,^1,2 persistent tolerance after discontinuation of use of fenfluramines may signal brain serotonin neural injury.

Dr Mattes raises the important question of whether classic psychostimulants might be safer than fenfluramine(s) for the purposes of weight loss. While this may be true for phentermine and possibly other amphetamine derivatives (eg, methylphenidate), issues other than potential neurotoxic effects (eg, abuse liability, tolerance) also need to be considered when evaluating drug safety.

Drs O'Callaghan and Miller contest our assertion that the available data . . . [Full Text PDF of this Article]

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