Takotsubo Cardiomyopathy Due to Combined Use of Phentermine and Lisdexamfetamine

OBJECTIVES: This is the first case report of iatrogenic Takotsubo syndrome (TS) due to a combination of lisdexamfetamine and phentermine. BACKGROUND: TS is characterized by transient acute ballooning of the left ventricular wall. Typically, it occurs in extremely stressed post-menopausal women, however a few iatrogenic causes have been described recently. RESULTS: A 55-year old woman prescribed lisdexamfetamine and phentermine, presented with acute substernal chest pain. Acute coronary syndrome was excluded. The echocardiogram was diagnostic of TS, and she recovered spontaneously, with supportive care. CONCLUSION: Caution with the use of sympathomimetic medications in post-menopausal women appears warranted. LEARNING POINTS: This is the first case report in the published English literature of medication-induced Takotsubo cardiomyopathy due to combination use of lisdexamfetamine and phentermine. This provides new information about iatrogenic causes of Takotsubo cardiomyopathy. Caution is indicated in the use of such medications, particularly in post-menopausal women, who are at higher risk.