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Intravenous prophylhexedrine (Benzedrex®) abuse and sudden death
The American Journal of Medicine
|July 1, 1979
Summary
Propylhexedrine abuse, particularly from the Benzedrex® inhaler, has been linked to 15 deaths. Sudden fatalities often showed pulmonary hypertension and right ventricular hypertrophy, suggesting a need for awareness in drug abuse cases.
Area of Science:
- Forensic Pathology
- Toxicology
- Cardiovascular Pathology
Background:
- Propylhexedrine, a stimulant found in over-the-counter nasal decongestants like Benzedrex®, has been associated with adverse health events.
- Previous reports have highlighted the potential for abuse and associated fatalities, necessitating further investigation into its toxicological profile.
Observation:
- A review of 15 deaths investigated by the Dallas County Medical Examiner since 1973 revealed propylhexedrine as a contributing factor in several cases.
- Twelve of these deaths were directly linked to the intravenous abuse of propylhexedrine extracted from Benzedrex® inhalers.
Findings:
- The majority of propylhexedrine-related deaths were sudden, with frequent postmortem findings including pulmonary edema, foreign body granulomas, fibrosis, and pulmonary hypertension.
- Right ventricular hypertrophy was observed in nine out of the 12 individuals who died from intravenous propylhexedrine abuse.
- Additional cases included two homicides and one suicide where propylhexedrine was implicated.
Implications:
- Intravenous propylhexedrine abuse should be considered in the differential diagnosis for unexplained right ventricular hypertrophy and pulmonary hypertension.
- Sudden death cases in young adults with evidence of intravenous drug abuse warrant suspicion for propylhexedrine toxicity.
- This highlights the critical need for awareness among medical examiners and clinicians regarding the dangers of abusing propylhexedrine-containing products.