Phenylpropanolamine and the risk of hemorrhagic stroke

Walter N. Kernan, Catherine M. Viscoli, Lawrence M. Brass, Joseph P. Broderick, Thomas G Brott, Edward Feldmann, Lewis B. Morgenstern, Janet Lee Wilterdink, Ralph I. Horwitz

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Abstract

Background: Phenylpropanolamine is commonly found in appetite suppressants and cough or cold remedies. Case reports have linked the use of products containing phenylpropanolamine to hemorrhagic stroke, often after the first use of these products. To study the association, we designed a case-control study. Methods Men and women: 18 to 49 years of age were recruited from 43 U.S. hospitals. Eligibility criteria included the occurrence of a subarachnoid or intracerebral hemorrhage within 30 days before enrollment and the absence of a previously diagnosed brain lesion. Random-digit dialing identified two matched control subjects per patient. Results There were 702 patients and 1376 control subjects. For women, the adjusted odds ratio was 16.58 (95 percent confidence interval, 1.51 to 182.21; P=0.02) for the association between the use of appetite suppressants containing phenylpropanolamine and the risk of a hemorrhagic stroke and 3.13 (95 percent confidence interval, 0.86 to 11.46; P=0.08) for the association with the first use of a product containing phenylpropanolamine. All first uses of phenylpropanolamine involved cough or cold remedies. For men and women combined, the adjusted odds ratio was 1.49 (95 percent confidence interval, 0.84 to 2.64; P=0.17) for the association between the use of a product containing phenylpropanolamine and the risk of a hemorrhagic stroke, 1.23 (95 percent confidence interval, 0.68 to 2.24; P=0.49) for the association with the use of cough or cold remedies that contained phenylpropanolamine, and 15.92 (95 percent confidence interval, 1.38 to 184.13; P=0.03) for the association with the use of appetite suppressants that contained phenylpropanolamine. An analysis in men showed no increased risk of a hemorrhagic stroke in association with the use of cough or cold remedies containing phenylpropanolamine. No men reported the use of appetite suppressants. Conclusions: The results suggest that phenylpropanolamine in appetite suppressants, and possibly in cough and cold remedies, is an independent risk factor for hemorrhagic stroke in women.

Original languageEnglish (US)
Pages (from-to)1826-1832
Number of pages7
JournalNew England Journal of Medicine
Volume343
Issue number25
DOIs
StatePublished - Dec 21 2000

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Phenylpropanolamine
Stroke
Appetite Depressants
Cough
Confidence Intervals
Odds Ratio
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Case-Control Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kernan, W. N., Viscoli, C. M., Brass, L. M., Broderick, J. P., Brott, T. G., Feldmann, E., ... Horwitz, R. I. (2000). Phenylpropanolamine and the risk of hemorrhagic stroke. New England Journal of Medicine, 343(25), 1826-1832. https://doi.org/10.1056/NEJM200012213432501

Phenylpropanolamine and the risk of hemorrhagic stroke. / Kernan, Walter N.; Viscoli, Catherine M.; Brass, Lawrence M.; Broderick, Joseph P.; Brott, Thomas G; Feldmann, Edward; Morgenstern, Lewis B.; Wilterdink, Janet Lee; Horwitz, Ralph I.

In: New England Journal of Medicine, Vol. 343, No. 25, 21.12.2000, p. 1826-1832.

Research output: Contribution to journalArticle

Kernan, WN, Viscoli, CM, Brass, LM, Broderick, JP, Brott, TG, Feldmann, E, Morgenstern, LB, Wilterdink, JL & Horwitz, RI 2000, 'Phenylpropanolamine and the risk of hemorrhagic stroke', New England Journal of Medicine, vol. 343, no. 25, pp. 1826-1832. https://doi.org/10.1056/NEJM200012213432501
Kernan WN, Viscoli CM, Brass LM, Broderick JP, Brott TG, Feldmann E et al. Phenylpropanolamine and the risk of hemorrhagic stroke. New England Journal of Medicine. 2000 Dec 21;343(25):1826-1832. https://doi.org/10.1056/NEJM200012213432501
Kernan, Walter N. ; Viscoli, Catherine M. ; Brass, Lawrence M. ; Broderick, Joseph P. ; Brott, Thomas G ; Feldmann, Edward ; Morgenstern, Lewis B. ; Wilterdink, Janet Lee ; Horwitz, Ralph I. / Phenylpropanolamine and the risk of hemorrhagic stroke. In: New England Journal of Medicine. 2000 ; Vol. 343, No. 25. pp. 1826-1832.
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AU - Brott, Thomas G

AU - Feldmann, Edward

AU - Morgenstern, Lewis B.

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