Dangers of Phenylpropanolamine- Hemorrhagic Stroke

"Dangers of Phenylpropanolamine"

What out for certain diet and cold remedies!

Food and Drug Administration (FDA) advisors voted this week that phenylpropanolamine, the active ingredient in many decongestant cold remedies and nonprescription dietary supplements, cannot be classified as safe. "Safe classification" is currently required to sell drugs not requiring a prescription. 1

Although exact numbers are not known FDA advisors and other scientists believe phenylpropanolamine may be responsible for 200-500 hemorrhagic (bleeding) strokes each year with many of these occurring in younger persons less than 50 years of age.

Hemorrhagic strokes, occurring when a blood vessel in the brain "bursts" causing blood to fill surrounding brain areas, account for about 20% of all strokes. However, these strokes are the deadliest and most disabling of all strokes. Risk factors for hemorrhagic stroke includes: high blood pressure, smoking, blood-thinning medications, as well as use of the stimulants cocaine and methamphetamine.

What products contain phenylpropanolamine?

Many nonprescription combination cold products and dietary weight loss medications contain phenylpropanolamine. Examples include Triaminic™ and Dexatrim™. There are many more preparations not listed here. The consumer is advised to check the "Ingredients" section of all such preparations.

What is phenylpropanolamine and what does it do?

Phenylpropanolamine (PPA) is a stimulant and vasoconstrictor. Depending in the dose taken it causes bronchial airway dilation (beneficial in asthmatics), increased heart rate and blood vessel constriction.

Blood vessel constriction is useful in treating nasal congestion but can be harmful by increasing blood pressure. In dietary supplements it is used for its modest appetite suppressant effect. PPA is very similar in structure and action to ephedrine except it causes less nervous system stimulation ("feeling wired"). Other similar stimulants in use include pseudoephedrine and phenlyephrine.

Safety record 1

Phenylpropanolamine (PPA) has been commonly used in over-the-counter preparations for more than 20 years with up to an estimated 6 billion doses sold each year in the United States.

FDA records show 44 hemorrhagic strokes among PPA users in the past 30 years. Most were women with the median age being 35. The risk was determined to be the greatest within the first 3 days of PPA use, whether for diet or cold treatment.

Bottom Line

Phenylpropanolamine (PPA) likely poses a very small, but real, risk for the average dieter or cold suffer. However, it must be remembered that the actual number of victims may be many times greater than the reported number. PPA is a stimulant that can increase blood pressure, a known contributing factor to hemorrhagic stroke.

For suffers of cold induced nasal congestion the use of a long acting (12 hour) topical nasal decongestant spray, typically containing oxymetolazine as the active ingredient, not exceeding 3 consecutive days use is likely to be much more effective and without the side effects of medication taken by mouth.

Dieters should be aware that all currently effective appetite supressants on the market are stimulants. Although such appetite supressants sometimes result in short term weight loss no well designed studies have demonstrated the ability of these medications to keep weight off. Amphetamines were commonly prescribed for weight loss in the 1960's and worked quite well for a period of time. Fortunately, the limitations on long term amphetamine use ( anorexia, exhaustion, paranoia) are now recognized.

The only long term success in weight control for the vast majority of dieters comes by combining sensible diet, realistic expectations, and modest physical activity. A diet should be something a person can practice for life.

The bottom line is that PPA is not the most effective drug for asthma, nasal congestion or diet control. If you choose to use compounds containing PPA do not take higher than recommended doses.

Resources

1. From "Element in Diet, Cold Drugs Ruled Unsafe", Associated Press in Los Angeles Times, A16, Oct. 20, 2000