title: Stroke associated with sympathomimetics contained in over-the-counter cough and cold drugs.
abstract: OBJECTIVE
  Phenylpropanolamine (PPA) and pseudoephedrine are sympathomimetics contained in over-the-counter cold preparations. A case-control study linked PPA use with hemorrhagic stroke in women. Twenty-two patients with stroke associated with use of these drugs are described.
  
  
  METHODS
  In a consecutive stroke registry since 1988, 22 patients had stroke associated with over-the-counter sympathomimetics. Sympathomimetic dosage and type, time interval until stroke onset, and neuroimaging findings are described.
  
  
  RESULTS
  Ten male and 12 female patients were included. Intracerebral hemorrhage occurred in 17 patients, subarachnoid hemorrhage in 4, and ischemic stroke in 1. Stroke was associated with PPA use in 16 patients (dose 75 to 675 mg), with pseudoephedrine in 4 (dose 60 to 300 mg), and with others administered by the nasal route in 2 (oxymetazoline and phenylephrine). Stroke occurred after a single dose in 17 patients and after daily use during several days in 5. The interval between drug exposure and clinical onset varied from 30 minutes to 24 hours. Stroke occurred after recommended doses of PPA (50 to 75 mg) in 32% and pseudoephedrine (60 mg) in 50% of patients. Eight patients had acute hypertension at stroke onset. Cerebral angiography was normal in 8 cases and showed diffuse vasospasm or beading in 10 patients.
  
  
  CONCLUSIONS
  Stroke related to over-the-counter sympathomimetics was associated with acute hypertension and/or vasospasm or angiitis mechanisms, most related to the use of PPA; however, stroke also occurred with the use of other sympathomimetics, particularly pseudoephedrine. Although stroke complications occurred when doses were used that were higher than recommended doses, apparently there is also a stroke risk when these agents are taken properly.
authors.affiliation: Stroke Clinic, National Institute of Neurology and Neurosurgery, Tlalpan, Mexico. carloscantu_brito@hotmail.com
authors.forename: Carlos
authors.initials: C
authors.lastname: Cantu
authors.forename: Antonio
authors.initials: A
authors.lastname: Arauz
authors.forename: Luis M
authors.initials: LM
authors.lastname: Murillo-Bonilla
authors.forename: Mario
authors.initials: M
authors.lastname: López
authors.forename: Fernando
authors.initials: F
authors.lastname: Barinagarrementeria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D015984:Causality; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004809:Ephedrine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000009:adverse effects*; D010109:Oxymetazoline / Q000009:adverse effects; D010665:Phenylpropanolamine / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D013566:Sympathomimetics / Q000009:adverse effects*
chemical_list: D004366:Nonprescription Drugs; D013566:Sympathomimetics; D010665:Phenylpropanolamine; D010109:Oxymetazoline; D004809:Ephedrine