Clomiphene misuse and risk of severe cardiovascular events
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LETTER TO THE EDITOR
Clomiphene misuse and risk of severe cardiovascular events Céline Eiden 1 & Véronique Pinzani 1 & Marion Laureau 2 & Nicolas Chapet 3 & Juline Beringer 2 & François Roubille 3,4 & Mustapha Sebbane 2 & Hélène Peyrière 1 Received: 16 February 2020 / Accepted: 8 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, Clomiphene is a selective oestrogen receptor modulator usually used to treat subfertility in women. However, misuse of clomiphene was recently reported in men by bodybuilders, and to treat infertility [1]. Here, we present the case of 2 subjects with severe cardiovascular complications due to clomiphene misuse in a performance-enhancing drug context that occurred in 2019 in a French area.
Case 1 A 24-year-old man presented at 2:00 p.m. to the emergency unit for tachycardia and palpitations. The patient reported intense strength activity using anabolic-androgenic steroids periodically (2 or 3 months ago) for several months and was currently on clomiphene. On admission, the physical examination revealed a heart rate of 108 beats/min and elevated blood pressure of 183/99 mmHg. Cardiac examination revealed a regular rate and rhythm, and electrocardiography revealed sinus tachycardia. Cardiac biomarkers and chest radiography were normal. Troponin value was 5 ng/ml (normal value < 14) and creatinine-kinase was 330 U/ml. Electrolyte levels and renal function were normal. No other medical
* Céline Eiden [email protected] 1
Department of Medical Pharmacology and Toxicology, Montpellier University Hospital, 34295 Montpellier Cedex 5, France
2
Department of Emergency, Montpellier University Hospital, 34295 Montpellier Cedex 5, France
3
Department of Cardiology, Montpellier University Hospital, 34295 Montpellier Cedex 5, France
4
PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier Cedex 5, France
history was noted. The last clomiphene intake was in the morning at 8 a.m. (one 50-mg tablet). His symptoms improved without treatment a few hours later, and he was discharged at 6:00 p.m. with the recommendation to stop clomiphene use.
Case 2 A 30-year-old man was hospitalized for acute myocardial infarction (MI) complicated by recovered cardiac arrest. Coronary angiography showed a suspended thrombus into the inter-anterior ventricular with no sign of atheromatous coronary artery disease. A bolus of eptifibatide (Integrelin®) was administered followed by a thromboaspiration, and a stent was placed. Aspirin, ticagrelor, heparin, and bisoprolol were started. The patient had a history of testosterone injections as doping substances. He recognized tobacco and cannabis smoking (10 pack-year and 3–4 cannabis uses/day). Except for being overweight (body mass index 29.3), no other conventional risk factor for MI was detected in this very young patient. The day before, he had taken 2 pills of 50 mg of clomiphene and one the day of the event. Urine toxicological analyses were positive for cannabinoids, and negative for amphetamin
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