Adverse drug effects attributed to phenylpropanolamine: A review of 142 case reports

Lake, C. Raymond; Gallant, Sheryle J.; Masson, Elizabeth B.; Miller, Peggy

doi:10.1016/0002-9343(90)90299-s

Cited by 130 publications

(55 citation statements)

References 90 publications

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“…Most recently, Morgenstern et al showed association between high doses of Ephedra in over-the-counter products for weight loss and energy enhancement and occurrence of hemorrhagic stroke 13 . Until 1992, 142 cases of hemorrhagic stroke associated to exposition to phenylpropanolamine as nasal decongestants have been reported 14 . Between 1969 and 1991, there were 22 spontaneous reports of such relation to the FDA.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic stroke after naphazoline exposition: case report

Zavala

Pereira

Zétola

et al. 2004

Arq. Neuro-Psiquiatr.

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-Ten percent of all strokes are due to spontaneous cerebral hemorrhages. They are associated to drugs (licit and illicit) in 9.5% of all cases in young adults. This is a case report of a 44-year-old man, without previous morbidities, who presented a sudden onset headache and arterial hypertension 24 hours after use of naphazoline as nasal decongestant. Cranial tomography showed right thalamus hemorrhage. Cerebral angiography showed no aneurisms, vascular malformations or vasculitis. No other risk factors were found during investigation in this patient and the stroke was attributed to naphazoline exposition.KEY WORDS: hemorrhagic stroke, naphazoline, sympathomimetic drug.Acidente vascular encefálico hemorrágico após exposição à nafazolina: relato de caso RESUMO -Dez por cento de todos os eventos vasculares encefálicos são devido às hemorragias intracerebrais espontâneas, associados a drogas (lícitas e ilícitas) em 9,5% de todos os casos em adultos jovens. Relatamos o caso de um homem de 44 anos de idade, sem doenças prévias, que apresentou cefaléia súbita e hipertensão arterial 24 horas após o uso de congestionante nasal contendo nafazolina. A tomografia de crânio evidenciou hemorragia talâmica. Durante a investigação não foram encontrados outros fatores de risco e a hemorragia foi atribuída à exposição à nafazolina. PALAVRAS-CHAVE: doença vascular encefálica hemorrágica, nafazolina, droga simpaticomimética.Cerebrovascular diseases occur more frequently in elderly people. Peak incidence is between 7 th and 8 th decades 1,2 . Before age 55, incidence is 10% 3,4 and before 45 it falls to 3.9% 5 .Ten percent of all cerebrovascular events are due to hemorrhage 6 . Its estimated incidence in United States of America is 0.3/100000 in younger than 35 years old 7 . Main etiologies are vascular malformations, arterial hypertension and exposition to drugs (amphetamines, sympathomimetics and illicit drugs) 8,9 . In young adults, drugs are associated to 9.5% of ischemic and hemorrhagic stroke 10 .We report a case of exposition to sympathomimetic drug naphazoline followed by thalamic hemorrhage. CASEA 44 year-old previously healthy man, with no history of arterial hypertension, was admitted to the emergency department of Hospital de Clinicas, Federal University of Parana, complaining of headache and left arm weakness. Five days before he had had some flu-like symptoms and naphazoline nasal decongestant was prescribed. In the following day he had a sudden onset headache associated to nausea and vomiting. He then looked for medical attention. Blood pressure was 190/120 mmHg and captopril 50 mg as a single dose was prescribed. A couple of days latter he developed left hemiparesia that made him seek for our emergency department. There was no previous history of thrombotic disorders and there were no familiar stroke cases.On physical examination vital signs were normal including blood pressure (120/70 mmHg), with no positive signs on cardiopulmonary and abdominal examination. Neurological examination revealed an oriented ...

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Section: Discussionmentioning

confidence: 99%

Hemorrhagic stroke after naphazoline exposition: case report

Zavala

Pereira

Zétola

et al. 2004

Arq. Neuro-Psiquiatr.

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“…Action is also seen at the beta receptor and in the CNS; the CNS stimulation is thought to be responsible for its anorectic effects leading to its use in diet pills [36]. Adverse effects of the medication include headache, tremor, insomnia, agitation, chest pain with significant toxicity producing palpitations, and severe hypertension [37]. Use of PPA has been associated with hemorrhagic strokes, cerebral vasculitis as well as infarctions; it is thought to be an independent risk factor for hemorrhagic stroke in women [36,38].…”

Section: Phenylpropanolaminementioning

confidence: 99%

Toxicity of Weight Loss Agents

2012

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Introduction: With the rise of the obesity epidemic in the United States over the last several decades and the medical complications seen with it, weight loss and dieting have become a national public health concern. Discussion: Because of their increased use and availability through internet sales, several different dieting agents were reviewed for potential toxicity. These included: syrup of ipecac, cathartics, human chorionic gonadotropin hormone, 2,4 Dinitrophenol, guar gum, phenylpropanolamine, ma huang/ ephedra, caffeine, clenbuterol, fenfluramine, sibutramine, thyroid hormone, orlistat and cannabinoid antagonists. Conclusions: With the internet making even banned products readily accessible, healthcare providers need to be aware of the potential toxicities of a wide range of weight loss agents. Our review covered topics we thought to be most historically significant as well as pertinent to the practice of medical toxicology today.

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“…LipoKinetix was marketed as a dietary supplement for weight loss. Hepatic injury appears to be due to an idiosyncratic reaction, perhaps related to phenylpropanolamine [14] . Among other weight loss agents, Usnic acid should be suspected in case of severe hepatotoxicity [15] .…”

Section: Discussionmentioning

confidence: 99%

Drug-induced liver injury due to “natural products” used for weight loss: A case report

Tarantino

Pezzullo

Minno

et al. 2009

WJG

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Ta k i n g h e r b a l -e x t r a c t s t o l o s e w e i g h t i s a n underestimated health hazard. Often, these products contain active agents that can cause acute liver damage. In this case report, a 22-year-old female patient, who presented with a feature of cholestatic syndrome, was so sure that the "natural products" were not dangerous that she did not inform her physicians that she had taken them, making their task that much more challenging. Clinical presentation m i m i c k e d a c u t e c h o l e c y s t i t i s a n d t h e p a t i e n t underwent a cholecystectomy. Surgery was without any consequences and complications, although it did not completely cure the illness. She later admitted to having taken herbal remedies and this led to the correct diagnosis of phytotherapy-related hepatotoxicity and a successful therapeutic approach. The true incidence of phytotherapy-related hepatotoxicity and its pathogenic mechanisms are largely unknown. It is important to increase the awareness of both clinicians and patients about the potential dangers of herbal remedies.

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Adverse drug effects attributed to phenylpropanolamine: A review of 142 case reports

Cited by 130 publications

References 90 publications

Hemorrhagic stroke after naphazoline exposition: case report

Hemorrhagic stroke after naphazoline exposition: case report

Toxicity of Weight Loss Agents

Drug-induced liver injury due to “natural products” used for weight loss: A case report

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