Stroke Associated With Sympathomimetics Contained in Over-the-Counter Cough and Cold Drugs

Cantú, Carlos; Araúz, Antonio; Murillo-Bonilla, Luis Manuel; López, Marisol López; Barinagarrementería, Fernando

doi:10.1161/01.str.0000075293.45936.fa

Cited by 164 publications

(123 citation statements)

References 33 publications

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“…In VIPS, we found that infection was prevalent across stroke subtypes, arteriopathic and cardioembolic, suggesting a common mechanism. Another proposed causal pathway between infection and arteriopathic stroke is the use of cold remedies with vasoactive ingredients, 25 but little use of such medications was reported in our study and we found no association with AIS.…”

Section: Major Infection Major Infection Included Diagnoses Of Menin-contrasting

confidence: 74%

Infection, vaccination, and childhood arterial ischemic stroke

et al. 2015

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Objectives: Minor infection can trigger adult arterial ischemic stroke (AIS) and is common in childhood. We tested the hypotheses that infection transiently increases risk of AIS in children, regardless of stroke subtype, while vaccination against infection is protective. Methods:The Vascular Effects of Infection in Pediatric Stroke study is an international casecontrol study that prospectively enrolled 355 centrally confirmed cases of AIS (29 days-18 years old) and 354 stroke-free controls. To determine prior exposure to infections and vaccines, we conducted parental interviews and chart review.Results: Median (interquartile range) age was 7.6 years for cases and 9.3 for controls (p 5 0.44).Infection in the week prior to stroke, or interview date for controls, was reported in 18% of cases, vs 3% of controls, conferring a 6.3-fold increased risk of AIS (p , 0.0001); upper respiratory infections were most common. Prevalence of preceding infection was similar across stroke subtypes: arteriopathic, cardioembolic, and idiopathic. Use of vasoactive cold medications was similarly low in both groups. Children with some/few/no routine vaccinations were at higher stroke risk than those receiving all or most (odds ratio [OR] 7.3, p 5 0.0002). In an age-adjusted multivariate logistic regression model, independent risk factors for AIS included infection in the prior week (OR 6.3, p , 0.0001), undervaccination (OR 8.2, p 5 0.0004), black race (compared to white; OR 1.9, p 5 0.009), and rural residence (compared to urban; OR 3.0, p 5 0.0003).Conclusions: Infection may act as a trigger for childhood AIS, while routine vaccinations appear protective. Hence, efforts to reduce the spread of common infections might help prevent stroke in children. Neurology ® 2015;85:1459-1466 GLOSSARY AIS 5 arterial ischemic stroke; CI 5 confidence interval; IQR 5 interquartile range; OR 5 odds ratio; PFO 5 patent foramen ovale; SES 5 socioeconomic status; VIPS 5 Vascular Effects of Infection in Pediatric Stroke.

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Section: Major Infection Major Infection Included Diagnoses Of Menin-contrasting

confidence: 74%

Infection, vaccination, and childhood arterial ischemic stroke

et al. 2015

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“…When these agents are topically applied, case reports have suggested that excessive use or prolonged exposure beyond package labeling can lead to systemic exposure resulting in stroke, hypertension, and bradycardia. [306][307][308][309] Inhaled and oral OTC asthma products may contain potent nonselective sympathomimetic amines such as racepinephrine and ephedrine, and they have been associated with chest pain, hypertension, tachycardia, and hemoptysis. [310][311][312][313] Many of the newer aluminum-and magnesium-containing antacids have minimal to no sodium; however, other products for cough/cold and gastrointestinal ailments may contain sodium.…”

Section: Sodium-containing Medicationsmentioning

confidence: 99%

Drugs That May Cause or Exacerbate Heart Failure

Page¹,

O’Bryant²,

Cheng³

et al. 2016

Circulation

357

185

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Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity, drug-drug interactions, or both. This scientific statement is designed to serve as a comprehensive and accessible source of drugs that may cause or exacerbate heart failure to assist healthcare providers in improving the quality of care for these patients.

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“…There have been case reports of stroke associated with oxymetazoline, but none described cerebral vasoconstriction. 3,4 This case report illustrates that oxymetazoline can cause reversible segmental cerebral vasoconstriction, resulting in thunderclap headache.…”

Section: Commentsmentioning

confidence: 92%