Episode 59

Propylhexedrine, the active ingredient in over-the-counter nasal decongestants, carries significant abuse potential for users seeking psychostimulant effects. Historically, propylhexedrine was perceived to have a good safety profile resulting in endorsement of it replacing the highly abused amphetamine sulfate as the active ingredient in nasal decongestants in 1949. While much of the published literature concerning its psychoactive potential comes from the 1970s and 1980s, we have encountered several recent cases of toxidrome secondary to its abuse...

In 1949, propylhexedrine replaced amphetamine sulfate as the active ingredient in over the counter Benzedrex due to reports of widespread abuse, psychosis and sudden death. Since its introduction, cases of psychosis, myocardial infarction, pulmonary vascular disease, pulmonary hypertension, and sudden death attributed to propylhexedrine abuse have been well documented, usually in the form of single case reports. Although growing concerns during the 1980's regarding its abuse potential and its use as a precursor in the manufacture of compounds of even higher abuse potential caused propylhexedrine to be reviewed by the WHO Expert Committee on Drug Dependence, no formal studies of the dependence potential of propylhexedrine exists to date...

A death involving abuse of propylhexedrine and mitragynine is reported. Propylhexedrine is a potent α-adrenergic sympathomimetic amine found in nasal decongestant inhalers. The decedent was found dead in his living quarters with no signs of physical trauma. Analysis of his computer showed information on kratom, a plant that contains mitragynine, which produces opiumlike effects at high doses and stimulant effects at low doses, and a procedure to concentrate propylhexedrine from over-the-counter inhalers...