This is another case of how government (of the US anyway) is not capable of managing health care.
Phenylpropanolamine (which I will abbreviate as PPA since it saves time typing) has been on the market for decades. It has been non-prescription as long as I have been a doctor (almost 24 yrs). Doctors have known for as long as that (and longer) that it has the potential to cause cerebral hemorrhage; it can also provoke heart attacks and rhythm disorders. In the entire time I have been a physician I have not had one patient, nor have I been aware of any patients of my colleagues, who have had a hemorrhage or heart problem from PPA.
OTOH, aspirin which has been freely available since it's invention over 100 years ago is extremely dangerous. I have personally treated about 10 people who have had gastrointestinal hemorrhages from aspirin and one person who had a perforation of her intestine from aspirin and almost died. I have had about 5 patients who have had a GI bleed from ibuprofen.
It's all a matter of relative risk. Driving is dangerous; driving without a seatbelt is more dangerous; driving drunk without a seatbelt is even more dangerous; driving drunk without a seatbelt at 100 mph on an icy road at night with the lights off is even more dangerous. How many of you never drive because of the danger? How many of you have used aspirin (maybe not a fair question to a group of singers). The point is PPA is NOT that dangerous. Yet in the US, since the FDA banned it for EVERYONE, I can not even prescribe it to a person I judge to be one who could benefit from it because the risk is so low to that person.
The reason this came out is that many people use it as an appetite suppressant, particularly young women who are overweight and may have high blood pressure already. They were able to use it without supervision and consequently some had hemorrhages. IMO it is too dangerous for weight control but is useful for nasal decongestion or control of stress incontinence, if the benefit vs the risk is considered by a physician.
It should be available by prescription. I will predict that the FDA will reverse its stand next year and allow it to be by prescription.
BTW, MaHuang is similar in its effects but is still readily available to anyone in health food stores.
John
John J. Messmer, M.D. Assistant Professor, Family & Community Medicine Penn State College of Medicine
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