Editorial comment--Over-the-counter cold remedies and stroke.

Abstract

For decades a number of sympathomimetic drugs have been marketed as over-the-counter diet pills, decongestants, or both. During the 1980s and 1990s one of these, phenylpropanolamine (PPA), accounted for an estimated 5 billion doses annually in the United States. In humans PPA produces arousal; unlike amphetamine it does not produce euphoria. It is a recognized street drug, however, sometimes misrepresented as amphetamine (“look-alike pills”), and by mail order it has been available as a “legal stimulant.”1 Complications of PPA include acute hypertension, psychosis, seizures, and stroke, especially hemorrhagic. More than 30 case reports describe intracerebral or subarachnoid hemorrhage following either recommended or excessive dosage. Proposed mechanisms include surges of hypertension, cerebral vasospasm (sometimes evident at angiography), and vasculitis (in one case evident at leptomeningeal biopsy).2 In 2000 Kernan and coworkers reported results of a multicenter case-control study addressing the association of …