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Phenylpropanolamine (PPA) is a drug of the phenethylamine family used in
bronchial and nasal decongestants, and also as an appetite suppressant. There
are four optical isomers of phenylpropanolamine: d- and l-norephedrine, and d-
and l-norpseudoephedrine. D-norpseudoephedrine is also known as cathine, and
occurs naturally in the stimulant plant Catha edulis (khat). This isomer is
commonly used in European medications described as "phenylpropanolamine",
whereas in the United States a racemic mixture of d,l-norephedrine is usual. A
scientific study (Kernan et al. 2000) found an increased risk of hemorrhagic
stroke in women who used phenylpropanolamine, although it is not clear which
isomer is to blame. A study at the Yale University School of Medicine in 1999
had produced similar results. Reports of cases of hemorrhagic strokes in PPA
users had been circulating since the 1970s. In November 2000, the FDA issued a
public health advisory against the use of the drug. The agency estimates that
PPA caused between 200 and 500 strokes a year among 18-to-49-year-old users. An
item on the agenda of the 2000 Commission on Narcotic Drugs session called for
including norephedrine in Table I of United Nations Convention Against Illicit
Traffic in Narcotic Drugs and Psychotropic Substances
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