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Paul Pentel, MD

JAMA. 1984;252(14):1898-1903.

Abstract
Over-the-counter stimulants (phenylpropanolamine hydrochloride, ephedrine, pseudoephedrine, caffeine) are used widely as decongestants, anorectic agents, amphetamine substitutes, and "legal stimulants." Toxic effects may result from overdose, drug interactions, or diseases that increase sensitivity to sympathomimetic agents. The most important toxic effect of the a-adrenergic agonist phenylpropanolamine is hypertension, which may result in hypertensive encephalopathy or intracerebral hemorrhage. The therapeutic index of phenylpropanolamine is low, and severe hypertension may occur after ingestion of less than three times the therapeutic dose. Ephedrine and pseudoephedrine may also cause hypertension, as well as tachyarrhythmias due to β-adrenergic stimulation. Toxic reactions from caffeine are characterized by agitation, seizures, tachyarrhythmias, and hypotension. Management of toxic reactions to over-the-counter stimulants includes control of hypertension with a rapidly acting vasodilator, β-blockers for tachyarrhythmias, and control of seizures.

(JAMA 1984;252:1898-1903)

Author Affiliations
From the Section of Clinical Pharmacology and Toxicology, Department of Medicine, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis.

Footnotes
Read in part before the San Francisco Bay Area Regional Poison Control Center's Fourth Annual Symposium on Recognizing and Managing Poisonings and Toxicological Emergencies, San Francisco, June 4, 1982.

Reprint requests to Department of Medicine, Hennepin County Medical Center, 701 Park Ave S, Minneapolis, MN 55415 (Dr Pentel).

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