Abstract
<h3>In Reply.—</h3> The observation that recommended doses of phenylpropanolamine are usually safe is correct, and neither this letter nor my review disputes that. The salient point regarding phenylpropanolamine toxicity is that the drug has a very low therapeutic index and that doses only slightly in excess of those used therapeutically can cause severe hypertension. Recent reports of fatal intracerebral hemorrhage, hypertensive encephalopathy, ventricular arrhythmias, and myocardial injury due to phenylpropanolamine illustrate the potential toxicity of this drug. Dr Lasagna is correct in pointing out that the Australian study<sup>1</sup>involved the use of 85 mg of phenylpropanolamine, but this dose is only 2.3 (not 3.5) times the maximum dose of 37.5 mg allowed in immediate-release anorectic preparations in the United States. Cuthbert et al<sup>2</sup>reported a comparable elevation of blood pressure in normal subjects after ingestion of 100 mg of phenylpropanolamine, with mean increases of 26 mm Hg systolic
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