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When caffeine is added to the equation, the likelihood (and severity) of adverse effects is multiplied, due most likely to the fact that PPA can produce dramatic increases in blood caffeine levels.14 Cases have been reported where individuals suffered manic psychosis after ingesting caffeine and PPA.15 The effects of the widely consumed drugs caffeine and phenylpropanolamine are mediated through activation of the central and sympathetic nervous systems

One might have expected Humphry to self-deliver particularly when he started to experience more symptoms of congestive heart failure

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