Table 1

Drugs associated with valvular heart disease

DrugsAssociation with DIVHDAffected valvesDose-dependencyReversibilityRemarksReferences
ErgotamineLikely: CRAV, MV and TVNot reportedNot reportedMigraine8
MethysergideLikely: CRAV and MVNot reportedNot reportedMigraine8
(dex)fenfluramineConfirmed: CR, CT, M, in vivo and in vitro dataAV, MV, and TV
AR: OR 2.2 (1.7–2.7)
MR: OR 1.6 (1.05–2.3)
YesYesCompletely withdrawn from market4 9–12
PergolideConfirmed: CR, CT, M, in vivo and in vitro dataAV, MV and TV OR 3.1 (1.7–5.7)YesYesWithdrawn from market in several countries13–16
CabergolineConfirmed: CR, CT, M, in vivo and in vitro dataAV, MV and TV
OR 6.4 (3.2–12.8)
YesNot reportedIn low-dose regimes for prolactinoma: no association with DIVHD13 14 16–18
BromocriptineDoubtful: One positive CR and CT. Negative CT and M.AV, MV and TVYes—one CTNot reportedFrequently used in Asia for Parkinson's disease19
MDMA (Ectasy)Likely: one CT, in vivo and in vitro dataAV and MVNot reportedNot reportedMostly used as illicit recreational drug3
BenfluorexVery likely: CR, CTAV, MV and TV
OR 3.1 (2.4–4)
Yes; one CTNot reportedCompletely withdrawn from market20 21
  • Adapted from Droogmans et al8

  • CR, Case reports with histopathology; CT, retrospective case-control trial; M, meta-analysis; in vitro and in vivo evidence; AV, aortic valve; MV, mitral valve; TV, tricuspid valve.