Medical Consequences of Over-the-Counter (OTC) Substance Abuse
John Brick in Handbook of the Medical Consequences of Alcohol and Drug Abuse, 2012
Ephedrine is a potent central nervous stimulant that directly stimulates alpha and beta adrenergic receptors and indirectly causes stimulation through release of norepinephrine. It increases heart rate and blood pressure, and causes bronchodilation. Pseudoephedrine is a nasal decongestant isomer of ephedrine with less potent central nervous system and cardiovascular effects (Bruno, Nolte, and Chapin, 1993; Hardman, Limbird, and Gilman, 2001). Propylhexedrine is an alpha-adrenergic sympathomimetic with onetwelfth the central nervous system stimulant effects of amphetamine (Garriott, 1975).
Pulmonary hypertension induced by drugs and toxins
Philippe Camus, Edward C Rosenow in Drug-induced and Iatrogenic Respiratory Disease, 2010
Propylhexedrine is an amphetamine-like appetite suppressant (see Fig. 29.2). One case of PAH, which developed over a period of 8 years of use, was reported in 1984, in a 39-year-old woman.42 Twelve months after the discontinuation of propylhexedrine, pulmonary symptoms and electrocardiographic signs of the right ventricular hypertrophy were resolved. Propylhexedrine is commonly found in over-the-counter remedies for colds, allergies and allergic rhinitis, and for temporary symptomatic relief of nasal congestion.
A comparative analysis of kratom exposure cases in Thailand and the United States from 2010-2017
Published in The American Journal of Drug and Alcohol Abuse, 2021
Christian Davidson, Dazhe Cao, Taylore King, Stephanie T. Weiss, Sunun Wongvisavakorn, Natthasiri Ratprasert, Satariya Trakulsrichai, Sahaphume Srisuma
Despite significant differences in occurrence of respiratory depression in the US versus Thailand, intubation rates did not differ significantly by country, occurring in 7.33% of reported kratom use cases. Amphetamine and other stimulant co-ingestions were more prevalent in Thailand, and stimulant co-ingestion was also noted to be a risk factor for intubation. The reasons for this are unclear, but we hypothesize that some patients, particularly those with stimulant co-ingestions, may have been intubated in order to control their agitation. The report of a death in a patient who used kratom along with the potent α-adrenergic stimulant propylhexedrine supports the idea of stimulant co-ingestion with kratom possibly leading to life-threatening sympathomimetic toxicity (43).
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