Propylhexedrine

coronary artery disease, uncontrolled hypertension, pulmonary hypertension, heart failure, arrhythmia

Pre-existing cardiovascular disease, uncontrolled hypertension, or history of pulmonary hypertension significantly amplifies risk. Propylhexedrine causes pulmonary hypertension even with oral-only use (Cameron 1984), and cardiovascular toxicity is the leading cause of propylhexedrine-related death (Anderson et al. 1979, 15 deaths documented).

Propylhexedrine, as a CNS stimulant, may lower seizure threshold. No propylhexedrine-specific seizure data exist; this is a class-level concern for sympathomimetic stimulants.

Class-level contraindication for sympathomimetic stimulants. Hyperthyroidism produces endogenous sympathetic activation; exogenous sympathomimetic stimulation compounds cardiovascular risk.

Class-level contraindication for sympathomimetic agents. Catecholamine-secreting tumors combined with exogenous monoamine release risk severe hypertensive crisis.

No published data on propylhexedrine safety in pregnancy or lactation were identified. Sympathomimetic vasoconstriction poses theoretical risk to uteroplacental blood flow. Class-level concern for all sympathomimetic agents.

isocarboxazid, phenelzine, tranylcypromine, selegiline, linezolid, moclobemide

Concurrent use of monoamine oxidase inhibitors (isocarboxazid, phenelzine, tranylcypromine, selegiline, linezolid) or use within 14 days of MAOI discontinuation is absolutely contraindicated. The combination risks catastrophic hypertensive crisis from uncontrolled norepinephrine accumulation. This contraindication is class-derived for all sympathomimetic releasing agents; no published case report of propylhexedrine specifically combined with an MAOI was identified.

SSRIs, SNRIs, serotonergic agents

Propylhexedrine has been described as having serotonin-releasing activity (SNDRA), though norepinephrine and dopamine are the primary effectors. If SERT activity is clinically significant, combinations with SSRIs, SNRIs, or other serotonergic medications could precipitate serotonin syndrome.

Class-level contraindication for sympathomimetic agents causing mydriasis. Propylhexedrine causes pupil dilation; in individuals with narrow anterior chamber angles, this can precipitate acute angle-closure glaucoma.