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Antihistamines, Decongestants, and Expectorants during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Phenylpropanolamine and phenylephrine are decongestants in wide use, and are commonly combined with various antihistamines in flu and cold over-the-counter preparations. Phenylephrine may also be used for the treatment of acute hypotension.
Pharmacological Treatment of Orthostatic Hypotension
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
Phenylpropanolamine hydrochloride (widely used in over-the-counter appetite suppressants and cold remedies) is a direct a-agonist and acts directly to release noradrenaline (Trendelenburg et al., 1962). Doses of 12.5-25 mg produced an average rise greater than 30/15 mmHg for 90 min in 12 seated patients (Biaggioni et al., 1987). These doses have little or no pressor effects in normal subjects. Little information is available on its chronic use.
Adrenoceptors: Classification and Distribution
Published in Kenneth J. Broadley, Autonomic Pharmacology, 2017
Early studies showed that the sympathomimetic compound, phenylpropanolamine (norephedrine), could be used in the treatment of obesity to produce weight loss (Hirsch 1939). This compound has consequently been available in the USA as an OTC weight-reducing remedy for many years. In spite of some controversy over its efficacy, the FDA has approved the continued sale of phenylpropranolamine-containing products for weight loss. Its combination with caffeine, however, is no longer used. Unlike amphetamine, which is closely related structurally (see Table 4.1), phenylpropranolamine does not appear to exert significant appetite supression and weight loss by a central anorexic mechanism. It is virtually free of CNS stimulant activity and therefore should not be regarded as a look-alike, amphetamine-type, stimulant drug of abuse, although it may appear on the streets as such. More recent studies showed that ephedrine reduced body lipid (but not protein) in various obese mice (Massoudi & Miller 1977). Also, phenylpropranolamine has been shown to increase thermogenic energy expenditure in normal and genetically obese mice. This was associated with decreased body weight gain, decreased total body fat and reduced food intake (Arch et al. 1982). Phenylpropanolamine stimulates BAT thermogenesis in rats, an effect that is abolished by pretreatment with reserpine to deplete endogenous catecholamines. This suggests that the effect is due to release of noradrenaline from noradrenergic neurones (Lasagna 1988).
The safety of treatment options for acute bacterial skin and skin structure infections
Published in Expert Opinion on Drug Safety, 2019
Matteo Bassetti, Maddalena Peghin, Nadia Castaldo, Daniele Roberto Giacobbe
Linezolid, the first marketed oxazolidinone, is usually active against various MDR gram-positive bacteria, including MRSA [101]. Amongst possible AE during linezolid treatment are myelosuppression and gastrointestinal side effects [102]. Myelosuppression (mainly thrombocytopenia and usually reversible) most frequently occurs with duration longer than 14 days, especially in individuals with end-stage renal disease [102,103]. Lactic acidosis, peripheral neurotoxicity, and optic neurophaty are others uncommon but possible linezolid-associated AEs, usually presenting after at least 28 days of treatment [104,105]. In addition, linezolid has peculiar drug–drug interactions due to its activity as an inhibitor of monoamine oxidase, with patients receiving linezolid along with selective serotonin reuptake inhibitors (SSRI) being at risk of developing serotonin syndrome (Table 2) [106]. Similarly, there is a risk for severe hypertension when linezolid is taken concomitantly with foods rich in tyramine, and also simultaneous administration of pseudoephedrine and phenylpropanolamine should be avoided [107]. In patients with renal impairment, dose adjustments could be necessary, and therapeutic drug monitoring (TDM) may be considered [108].
Methamphetamine exposures reported to United States poison control centers, 2000–2019
Published in Clinical Toxicology, 2021
Tiffany Chen, Henry A. Spiller, Jaahnavi Badeti, Alexandra R. Funk, Motao Zhu, Gary A. Smith
The rates of exposure to methamphetamine demonstrated an initial increase from the beginning of the study period through 2005 before rapidly decreasing until 2007, followed by an increase through the end of the study in 2019. These trends reflect the history of methamphetamine production and policy in the US and neighboring countries. By the mid-1990s, Mexican drug trafficking organizations were supplying the bulk of the US methamphetamine supply, supplemented by increasing numbers of clandestine domestic laboratories [5]. Methamphetamine was predominantly made from precursors like ephedrine and pseudoephedrine, which were readily available in large quantities without a prescription [13]. The Combat Methamphetamine Epidemic Act of 2005 went into effect in March 2006 [18] and restricted access to ephedrine, pseudoephedrine, and phenylpropanolamine. Canada, the main supplier of pseudoephedrine to Mexico, passed similar legislation in 2005 that limited the distribution of pseudoephedrine [19], and in 2008, Mexico placed a domestic ban on pseudoephedrine and ephedrine products [20]. Together, these efforts resulted in a decline in methamphetamine use in the US. However, Mexican drug trafficking organizations soon switched to using phenyl-2-propanone as a precursor [13,21], reigniting an increase in methamphetamine availability and use in the US. The observed decrease in methamphetamine cases in this study demonstrates the effectiveness of coordinated public policy. However, the impact was transient, and additional efforts are now needed to reverse the current upward trend in methamphetamine availability and use driven by international drug trafficking organizations.
Chemical pharmacotherapy for the treatment of orthostatic hypotension
Published in Expert Opinion on Pharmacotherapy, 2019
Phenylpropanolamine (β-hydroxyamphetamine) is a sympathomimetic drug that acts a selective norepinephrine-releasing agent. Following an open-label study that demonstrated a pressor effect of phenylpropranolamine at doses of 12.5–25 mg in 14 subjects with nOH [100], this effect was confirmed alongside that of several other pressor agents in a single-blind, placebo-controlled study [57].