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Type: Journal article
Title: Can perhexiline be utilized without long-term toxicity? A clinical practice audit
Author: Phuong, H.
Choi, B.
Chong, C.
Raman, B.
Horowitz, J.
Citation: Therapeutic Drug Monitoring, 2016; 38(1):73-78
Publisher: Lippincott Williams & Wilkins
Issue Date: 2016
ISSN: 0163-4356
Statement of
Helen Phuong, Bo Y Choi, Cher-Rin Chong, Betty Raman, John D. Horowitz
Abstract: Background: Perhexiline, originally used as a first-line prophylactic antianginal agent, is now regarded primarily as a treatment for otherwise refractory myocardial ischemia. Recent studies have also demonstrated its short-term utility in heart failure, hypertrophic cardiomyopathy, and inoperable aortic stenosis. Its benefits on myocardial energetics state are potentially counter-balanced by risk of hepatotoxicity and peripheral neuropathy during long-term treatment if drug accumulation occurs. Since perhexiline exhibits complex pharmacokinetics with wide inter-individual variability, its long-term use requires regular plasma concentration monitoring. In this study, the risk of neuro- and hepato-toxicity during long-term perhexiline therapy in relation to the intensity of therapeutic drug monitoring was investigated. Furthermore, determinants of mortality during perhexiline treatment were evaluated. Methods: In 170 patients treated with perhexiline for a median of 50 months (interquartile range: 31–94 months), outcomes and relationship to plasma drug concentrations were documented. Results: Rationale for treatment with perhexiline included myocardial ischemia in 88% and severe systolic heart failure in 38%. Plasma concentrations were within the therapeutic range of 150–600 ng/mL on 65% of assay occasions and toxic levels accounted for 8.8% of measurements. No patient developed hepatotoxicity attributable to perhexiline while 3 developed peripheral neuropathy possibly induced by treatment. Actuarial 5-year survival rate was 83% overall, and 76.3% in patients with associated systolic heart failure. Conclusions: This first audit of a large population treated long-term perhexiline demonstrates the following: (1) Although the frequency of monitoring is less than ideal, therapeutic drug monitoring effectively limits occurrence of toxic drug concentrations and virtually eliminates long-term hepato- and neuro-toxicity and (2) Mortality rates during long-term therapy, notably for patients with concomitant heart failure, are surprisingly low.
Keywords: Perhexiline; myocardial energetics; hepatotoxicity; peripheral neuropathy; safety
Rights: Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
RMID: 0030036030
DOI: 10.1097/FTD.0000000000000237
Appears in Collections:Medicine publications

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