Drs Blewitt and Siegel draw attention to several interesting issues. First, they state that we did not cite examples of phenylpropanolamine-associated complications in patients using the drug responsibly. Our patient 1, the patient described by Lee et al,1 and several patients described in the Lancet editorial,2 all were using phenylpropanolamine as directed and suffered side effects possibly associated with its use. Thus, the responsible use of phenylpropanolamine does not inevitably protect a person from an untoward reaction, although it might change the odds in that direction. Drs Blewitt and Siegel claim that several "controlled clinical studies" have not shown these adverse effects. If they have such data, they should provide specific citations. It is well known that adverse reactions to drugs may occur so infrequently that they would be observed only after a large patient population is exposed. Such a situation could be the case for
Golper TA, Bennett WM, Swenson RD. Renal Failure, Rhabdomyolysis, and Phenylpropanolamine-Reply. JAMA. 1983;249(22):3017–3018. doi:10.1001/jama.1983.03330460017016
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