Banned Cold Remedy Ingredient Increases Stroke Risk

Healthnotes Newswire (March 15, 2007)—Adverse reactions to over-the-counter drugs are a significant problem in the United States. A once-common danger on the drug store shelf, phenylpropanolamine (PPA) was banned in the US by the Food and Drug Administration (FDA) a few years ago, though it is still available in many other countries. A new study supports its ban by confirming that it increases women’s risk of stroke.

Stroke occurs when normal blood flow through one or more small vessels in the brain is altered, causing the area of the brain served by that vessel to be damaged. Hemorrhagic stroke occurs when a small vessel bleeds into the brain, usually because of increased pressure in the vessel.

PPA was a common ingredient in over-the-counter cold and cough medicines as well as appetite-suppressing diet aids. When a study in 2000 (the Hemorrhagic Stroke Project) found that women who used diet aids with PPA had an increased risk of hemorrhagic stroke, the FDA required drug companies to reformulate their weight loss and cold medicines without PPA, even though at the time it wasn’t known whether taking occasional cold medicine containing PPA would be as risky as regular use of diet medicines containing PPA.

In the new study, published in Neurology, researchers identified 940 people in Korea who had experienced hemorrhagic stroke and matched them with people who had not. The use of PPA-containing cold medicines was linked to higher risk of hemorrhagic stroke in women but not in men. Women who had used these medicines were nearly four times as likely to have experienced a stroke than women who had not. In addition, more recent use, longer use, and higher dose of PPA all increased stroke risk.

“When the FDA banned PPA, many pharmacists thought it was an overreaction to the evidence and wanted them to wait for more research,” said Neil Pease, a compounding pharmacist in Rutland, Vermont. “Over-the-counter nasal decongestants with PPA were very effective, and the current alternative—pseudoephedrine—creates other problems because it is used in the making of the street drug methamphetamine. People can’t buy cold medicines with pseudoephedrine without talking to the pharmacist and signing for the products.” Pease added that the FDA ban seems more appropriate in light of the current study’s findings.

To prevent stroke healthcare professionals recommend not smoking, maintaining normal weight, getting regular exercise, and keeping blood pressure normal. The results of this study show that avoiding over-the-counter drugs with PPA is also important.

(Neurology 2007;68:146–9)

Maureen Williams, ND, received her bachelor’s degree from the University of Pennsylvania and her Doctorate of Naturopathic Medicine from Bastyr University in Seattle, WA. She has a private practice in Quechee, VT, and does extensive work with traditional herbal medicine in Guatemala and Honduras. Dr. Williams is a regular contributor to Healthnotes Newswire.

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