A review recently published in the European Respiratory Journal Open Research provides the latest evidence on drug- and toxin-associated pulmonary arterial hypertension, offering clinicians updated guidance on recognition, diagnosis, and management of this pulmonary arterial hypertension subtype (see below for the most recent pulmonary arterial hypertension classification, at 1.3)
The first World Health Organization (WHO) conference on pulmonary hypertension was held in 1973 in response to a significant increase in the number of patients developing this condition in Switzerland, Germany and Austria in 1967 further to the introduction of an amphetamine-like appetite suppressant to treat obesity: aminorex. Since then the number of suspected agents has expanded significantly. Following the 6th World Symposium on Pulmonary Hypertension (2018), drugs and toxins were classified by strength of association (definitely associated: 9 agents, possibly associated: 16 agents). During the 7th World World Symposium on Pulmonary Hypertension (2024) a further 2 agents were added (definitely associated: 2, possibly associated 2).
Drugs definitely associated: Aminorex, Benfluorex, Carfilzomib, Dasatinib, Dexfenfluramine, Fenfluramine, Methamphetamines, Mitomycin C#, Toxic rapeseed oil
Drugs possibly associated: Alkylating agents, Amphetamines, Bevacizumab, Bortezomib, Bosutinib, Cocaine, Diazoxide, Direct-acting antiviral agents against hepatitis C virus (sofosbuvir), Indigo naturalis (Chinese herb Qing-Dai), Interferon, Leflunomide, L-Tryptophan, Phenylpropanolamine, Ponatinib, Solvents (trichloroethylene), St John’s wort
Read more at this link on the European Respiratory Society (ERS) website
Citation
Drugs and toxins associated with pulmonary arterial hypertension: from established culprits to novel threats, Julien Grynblat, Alex Hlavaty, Laurent Savale, ERJ Open Research 2025 11(6): 00382-2025; DOI: https://doi.org/10.1183/23120541.00382-2025
Group 1: Pulmonary arterial hypertension
1.1 Idiopathic
1.1.1 Long term responders to calcium channel blockers
1.2 Heritable
1.3 Associated with drugs and toxins
1.4 Associated with:
1.4.1 Connective tissue disease
1.4.2 HIV infection
1.4.3 Portal pulmonary hypertension
1.4.4 Congenital heart disease
1.4.5 Schistosomiasis
1.5 Pulmonary arterial hypertension with features of venous/capillary (PVOD/PCH) involvement
1.6 Persistent pulmonary hypertension of the newborn