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Detection of urinary amyloid in familial Mediterranean fever.

There seems little doubt that this hypertensive episode was caused by phenylpropanolamine. Although the combination of methyldopa and intravenous propranolol has occasionally produced severe hypertension2 there was no evidence of any major fluctuation in the patient's blood pressure until phenylpropanolamine was introduced. Methyldopa is known to increase the pressor effects of sympathomimetic amines3 and it has been postulated that beta-blockade may have a similar action by allowing an unopposed alpha-constrictor response to adrenergic stimulation.4 The combination of methyldopa and oxprenolol may therefore have caused a particular severe hypertensive reaction. The patient's renal failure might have exacerbated the effect since metabolites of methyldopa with possible pressor effects are increased in uraemia.5 In view of the widespread use of methyldopa and beta-blockers in combination it is surprising that an interaction with this amine has not been reported before. On this occasion the hypertension did not result in any permanent damage, but the consequences might be serious in patients with ischaemic heart disease. The manufacturers of Triogesic do give hypertension as a contraindication to its use but no mention is made of beta-blockers that might be given for other reasons. In addition phenylpropanolamine is a constituent of many cold cures obtainable without prescription, and although warnings are printed on the packet these may well be disregarded. It seems desirable that wider publicity should be given to the potentially serious effects of interaction of phenylpropanolamine with beta-blockers, methyldopa, and other drugs, which might well outweigh its very limited role as a nasal decongestant.