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(Stroke. 2003;34:1673.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Over-the-Counter Cold Remedies and Stroke

Department of Neurology, Harlem Hospital Center and Columbia University College of Physicians & Surgeons, New York, New York

An extract of the first 250 words of the full text is provided, because this article has no 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 PPA use and intracerebral or subarachnoid hemorrhage.³ Patients (n=702) and controls (n=1375) were 18 to 49 years of age. This study confirmed PPA as an independent risk factor for hemorrhagic stroke. The odds ratio was 16.58 (P=0.02) for women using appetite suppressants containing PPA and 3.13 (P=0.08) for women using cough or cold remedies containing PPA. For men there was no increased risk of hemorrhagic stroke in association with cough or cold remedies; no men reported use of appetite suppressants. The greater risk of appetite suppressants was attributed to higher dose, but strokes followed recommended as well as excessive doses, and with cough and cold . . . [Full Text of this Article]