Phenylpropanolamine and Strokes Hoax

By Michael Dorausch, D.C.

Phenylpropanolamine and Strokes – was it all a hoax?
Published: February 01, 2001

The news first surfaced around the weekend of November 3rd, 2000. A common cold medication and diet stimulant ingredient known as phenylpropanolamine was about to be banned by the U.S. Food and Drug Administration.

Planet Chiropractic posted our first news of the topic on the morning of November 6th, 2000 as a result of news we were gathering throughout the weekend. On that same morning, the U.S. Food and Drug Administration (FDA) issued a public health advisory that a common medicine ingredient (PPA) may increase the risk of stroke in some individuals.

Phenylpropanolamine (PPA), was commonly used in prescription and over-the-counter cold and cough products as a nasal decongestant and in over-the-counter weight control products.

On Nov. 7th, 2000, Planet Chiropractic sent out our first ever Public Service Announcement via e-mail. Included in the e-mail was a list of common over-the-counter medications that contained the PPA ingredient. A warning involving the increased risk of hemorrhagic stroke (bleeding on the brain) was also included and readers were encouraged to contact the FDA for more information.

While the FDA did not ban the substance on that day, they did take the step of requesting manufacturers of drugs containing PPA to remove them from the market voluntarily. News feeds quickly began filling up with reports from major pharmacy and supermarket chains across the U.S., Canada, and Mexico, that medications including the PPA ingredient were being pulled off of the shelves.

This was a drug ingredient that was being prescribed or distributed to billions of people. Surely it would be broadcast on every major news network for weeks to come thought many. And then came the U.S. presidential election. News of PPA appeared to fade as quickly as it surfaced. News coverage of the topic (as well as coverage of nearly any topic in the U.S.) ceased to make the airwaves since all eyes were focused on the U.S. presidential election.

Despite all that was going on with the election, slowly at first and then increasingly, news of our public service announcement began to grow. E-mails and Web traffic to Planet Chiropractic increased significantly but the feedback we were receiving was somewhat disturbing. Headlines from forwarded e-mails now read “PPA Hoax” along with the information of increased risk of hemorrhagic stroke and the listing of the over-the-counter medications.

At some point the tables turned and someone decided this could just not be true. Was that our American consciousness? Could so many everyday over-the-counter medications and diet supplements really be putting us at risk of hemorrhagic stroke? It was easy for many of us to believe that this was indeed a hoax and in there lies a message.

Do we have some kind of emotional attachment to the drugs we take? Do we believe that just because these drugs are available that they must be safe? The study suggested that the risk was slim, does that mean that it does not apply to us, our family, or someone that we know?

Not long after the public service announcement I received e-mail from some, including doctors, that this was not really a big issue and that the FDA should not have become involved. I actually thought about that and then days later I received the following e-mail:

“I had two Cerebral Vascular Accidents in 1998/1999 – strokes I am told. Anyway, I have always wondered what the cause was. When I read the article I was instantly reminded that on BOTH occasions I had taken a PPA containing medication the night before. Also about 4 months ago, I was admitted to Medicross because of a TIA – once again I had taken a PPA containing medication. Never put two and two together.”

“You are correct – doctors think that it is impossible and are not interested. They say that there is not enough evidence to substantiate the claim! Thank Goodness for Chiropractic – I should never have taken the things in the first place!”

Kind regards,
Name Withheld

So what does the report say?
Below are excerpts from the report.

Final Report of The Hemorrhagic Stroke Project
May 10, 2000

Since 1979, over 30 published case reports have described the occurrence of intracranial hemorrhage after PPA ingestion. Early reports involved diet pills including both PPA and caffeine, a combination that was removed from the market in 1983 because of abuse potential. Later reports involved use of PPA alone often as a reported first-ever dose.

In the Hemorrhagic Stroke Project of subjects between ages 18 and 49 years, PPA use was associated with an increased risk for hemorrhagic stroke. The increased risk was evident for PPA used as an appetite suppressant and for first use exposure. Because first uses of PPA in the HSP always involved cough-cold remedies, the association of PPA with risk for hemorrhagic stroke is present for both customary indications for PPA (as a cough-cold remedy and an appetite suppressant).

“Published” reports had been showing up since 1979, that’s more than 20 years ago. Many of you are just finding out about this information today for the first time. While it may not be phenylpropanolamine, what ingredient is next? What is the next over-the-counter medication, supplement, or dietary aid, that is going to be associated with some serious health risk? How long will you have been taking it before you hear about this unknown risk?

Here is one of the “non hoax” e-mails that we received in January, 2001:
Stop taking anything containing Phenylpropanolamine. It has been linked to increased hemorrhagic stroke (bleeding in brain) among women ages 18-49 in the three days after starting use of medication. Problems were not found in men, but the FDA recommended that everyone (even children) seek alternative medicine. My local CVS Pharmacy has a sign stating that all drugs containing this ingredient have been pulled from their shelves.

Call the 800 number listed on most drug boxes and inquire about a refund policy. The following medications contain Phenylpropanolamine:

Acutrim Diet Gum Appetite Suppressant Plus Dietary Supplements
Acutrim Maximum Strength Appetite Control
Alka-Seltzer Plus Children’s Cold Medicine Effervescent
Alka-Seltzer Plus Cold medicine (cherry or orange)
Alka-Seltzer Plus Cold Medicine Original
Alka-Seltzer Plus Cold & Cough Medicine Effervescent
Alka-Seltzer Plus Cold & Flu Medicine Effervescent
Alka-Seltzer Plus Cold & Sinus Effervescent
Alka Seltzer Plus Night-Time Cold Medicine Effervescent
BC Allergy Sinus Cold Powder
BC Sinus Cold Powder
Comtrex Deep Chest Cold & Congestion Relief
Comtrex Flu Therapy & Fever Relief Day & Night
Contac 12-Hour Cold Capsules
Contac 12 Hour Caplets
Coricidin D Cold, Flu & Sinus
Dexatrim Caffeine Free
Dexatrim Extended Duration
Dexatrim Gelcaps
Dexatrim Vitamin C/Caffeine Free
Dimetapp Cold & Allergy Chewable Tablets
Dimetapp Cold & Cough Liqui-Gels
Dimetapp DM Cold & Cough Elixir
Dimetapp Elixir
Dimetapp 4 Hour Liquid Gels
Dimetapp 4 Hour Tablets
Dimetapp 12 Hour Extentabs Tablets
Naldecon DX Pediatric Drops
Permathene Mega-16
Robitussin CF
Tavist-D 12 Hour Relief of Sinus & Nasal Congestion
Triaminic DM Cough Relief
Triaminic Expectorant Chest & Head Congestion
Triaminic Syrup Cold & Allergy
Triaminic Triaminicol Cold & Cough

I called the 800# for Triaminic and they informed me that they are voluntarily recalling the following medicines because of a certain ingredient that is causing strokes and seizures in children.

Orange 3D Cold & Allergy
Cherry (Pink) 3D Cold & Cough
Berry 3D Cough Relief
Yellow 3D Expectorant

They are asking you to call them at 800-548-3708 with the lot number on the box so they can send you postage for you to send it back to them, and they will also issue you a refund.

If you know of anyone else with small children, please pass this on.

Have you ever taken any of the above medications?
Would you believe that there are many who will read this and will proudly say “No.” Don’t you think that it would be better to choose a lifestyle that promoted better health and wellness and not merely just a focus on the removal of your symptoms?

Do I get colds? Yes, my body works very well thank you. And that’s the point. A cold is not a sickness, a cold is an opportunity for our body to express its innate intelligence. There is an inborn wisdom in each and every one of us that continues to allow our bodies to interact, comprehend, and adapt to our environments. Nurture this inborn wisdom and keep it free from interference (in chiropractic we call that the removal of subluxation) so that you can express your life to its full potential.

Just think of all the worry you would save yourself. The next time you hear that “Medical Minute” on your six o’clock news you can smile, look at your beautiful and healthy family and say “thank goodness for chiropractic!”