The incidence is rare, the possibility remote. Yet retailers across Canada and the United States spent last week voluntarily pulling dozens of cough and cold remedies off their shelves because of the potential risk of severe stroke posed by one key ingredient. Health Canada, following the lead of the U.S. Food and Drug Administration, issued a warning to consumers to stop using nonprescription medications containing phenylpropanolamine (PPA).
The government’s response came after U.S. studies linked the ingredient— which is identified clearly on the label of any medicine that contains it—to potentially fatal strokes. PPA is a stimulant that acts as a nasal decongestant in many cough and cold, sinus and allergy medicines, both prescription and nonprescription. It is also present in higher doses in some appetite suppressants sold in the United States. But PPA is not authorized for use in diet medications sold in Canada. Weight-loss remedies such as Dexatrim, sold in the United States with PPA, are formulated without it in Canada. Researchers at Yale University concluded that PPA in appetite suppressants and possibly in cough and cold remedies presented a risk of stroke to women. Men may also be at risk.
Both countries may ban the ingredient altogether after further study. PPA is contained in 63 types of popular cough and cold products available in Canada, including some formulations of Contac, Dimetapp, Triaminic, Sinutab and Ornade. Using them “is simply not worth the risk,” said Health Canada spokeswoman Roslyn Tremblay.
While the contentious products quickly disappeared from drugstore shelves, some remained on sale in convenience stores and other outlets. Canadians, meanwhile, can easily cope without PPA, says Daniel Sitar, head of the pharmacology department at the University of Manitoba. “If a stuffy nose is all you have,” he says, “there are other treatments to use. The question is whether it’s really advisable to use anything at all.”
For a list of medications with PPA and text of Health Canada’s warning www.macleans.ca
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