Kuchel: Phenylpropanolamine, stroke and hypertension [CMAJ

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Phenylpropanolamine, stroke and hypertension

CMAJ 2001;164(5):621 [PDF]

The US Food and Drug Administration has issued a warning about the danger of phenylpropanolamine (PPA), a decongestant and appetite suppressant that occurs in various over-the-counter and prescription medications, after a report by researchers at Yale University revealed a link between exposure to PPA and strokes in women.¹ For the last 20 years, one of the research interests of the Hypertension Group at the Montreal Research Institute has been patients with pseudopheochromocytoma, paroxysmal hypertension in the absence of pheochromocytoma.² Among many patients referred for this condition were 2 who had experienced hypertensive episodes that were evidently induced by PPA. This spurred me to write an article warning health care professionals about adverse reactions to PPA.³ It would have been desirable for Health Canada to have reacted to this warning at least as quickly as the 2 drug companies who responded to my article. Pennwalt Inc. put emphasis on its slow-release form of PPA, which was supposedly devoid of this effect, and asked me for a retraction.⁴ Thompson Medical Co. Ltd. tried to defend its marketing of another supposedly innocent PPA isomer.⁵ I reluctantly wrote a retraction, and I had to admit that fewer hypertension-producing isomers of PPA may be used in North America than in Europe and Australia.⁶ At that time, I was not aware of further studies indicating that adverse reactions had also been associated with slow-release formulations and with isomers of PPA.⁷ The present FDA warning¹ and various drugstore announcements of the withdrawal of PPA⁸ do not make a distinction between different PPA formulations either. It is conceivable that a more proactive response by Health Canada could have prevented the wide use of this potentially dangerous drug for the last 12 years.

Otto Kuchel
Emeritus Professor
Clinical Research Institute
Université de Montréal
Montreal, Que.

References

    1.    FDA issues public health warning on phenylpropanolamine. FDA Talk Paper T00-58; 6 Nov 2000. (accessed 5 Feb 2001).

    2.    Kuchel O. Pseudopheochromocytoma. Hypertension 1985;7(1):151-5. [MEDLINE]

    3.    Kuchel O. Watch for hypertension due to over-the-counter stimulants, appetite suppressants and decongestants. Hypertension Canada 1987;14:2.

    4.    Whitehead P. Phenylpropanolamine: letters to the editor, a reply, and new data from the Kyoto conference [letter]. Hypertension Canada 1988;4.

    5.    Jackson D. Phenylpropanolamine: letters to the editor, a reply, and new data from the Kyoto conference [letter]. Hypertension Canada 1988;4-5.

    6.    Kuchel O.: Phenylpropanolamine: letters to the editor, a reply, and new data from the Kyoto conference [letter]. Hypertension Canada 1988;5.

    7.    Bravo LE. Phenylpropanolamine. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis and management. New York: Raven Press Ltd.; 1990. p. 1911-6.

    8.    Pharmacie Jean Coutu message au sujet des médicaments contenant de la phénylpropanolamine. La Presse 2000 8 Nov;Sect 1:20.