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Pseudoephrine
Pseudoephedrine is used as a nasal decongestant1 and is an isomer of ephedrine.2 At higher doses, it may produce stimulant, appetite-suppressing, and performance-enhancing effects, although recreational effects are reportedly limited. It occurs naturally in ephedra,2 was first isolated in 18891, and was synthesized in the 1920s3. It can increase heart rate and blood pressure,4 with some people more sensitive to these effects.4 Rarely, it is associated with heart attack and hemorrhagic stroke.
Dosage & Duration
Dosage
Doses are population estimates that vary widely between individuals.
Duration
Subjective Effects
Pharmacology
Pharmacodynamics
Pseudoephedrine releases norepinephrine,5 indirectly activating adrenergic receptors.2 This sympathomimetic action constricts blood vessels5 and can increase blood pressure,2 heart rate, and the force of heart contractions.6
Pharmacokinetics
Pseudoephedrine readily enters the brain, although its hydrophilicity favors some peripheral selectivity. It is not metabolized by monoamine oxidase (MAO).6 More acidic urine increases its excretion and reduces exposure, while more alkaline urine slows its excretion and increases exposure.
Interactions
An unlisted combination is an unknown one, not a safe one. Check a dedicated combination chart before mixing.
Tolerance
Tolerance timelines are rules of thumb, not exact schedules, and vary widely between individuals and use patterns.
Harm Potential
Addiction & Dependence
Physical
A case report describes temporary depressive symptoms after pseudoephedrine discontinuation, including low mood, markedly reduced energy, poorer self-image, impaired concentration, psychomotor slowing, increased appetite, and increased need for sleep.
Toxicity
Deaths involving pseudoephedrine have been reported, but a human lethal dose is not established by these findings. Toxic effects can occur at supratherapeutic doses and in people with heightened sensitivity to sympathomimetics.2
Pseudoephedrine has rarely been associated with myocardial infarction, coronary vasospasm, serious arrhythmias, and sudden death; overdose can cause circulatory collapse, chest pain, tachycardia, palpitations, and increased or decreased blood pressure.
Pseudoephedrine has rarely been associated with hemorrhagic stroke.
Pseudoephedrine overdose can cause sedation, impaired concentration, coma, tremor, and ataxia.2
Pseudoephedrine overdose can cause apnea and cyanosis.7
The product information for an ibuprofen and pseudoephedrine combination lists ischemic colitis associated with pseudoephedrine hydrochloride at an unknown frequency and states that overdose may cause nausea and vomiting.7
Pseudoephedrine therapy has rarely been associated with severe skin reactions, including recurrent pseudo-scarlatina, systemic contact dermatitis, and non-pigmenting fixed drug eruption.
Pseudoephedrine overdose can cause difficulty urinating.2
Pseudoephedrine overdose can cause blurred vision.2
Psychosis Risk
The product information for an ibuprofen and pseudoephedrine combination lists hallucinations associated with pseudoephedrine hydrochloride at an unknown frequency and includes hallucinations among overdose symptoms.7
Seizure Risk
Pseudoephedrine overdose can cause convulsions.2
History & Culture
Pseudoephedrine occurs naturally alongside ephedrine in ephedra, an herb used for thousands of years in traditional Chinese medicine.8 In 1889, the German chemists Ladenburg and Oelschlägel first isolated and characterized pseudoephedrine using a sample extracted from…
Legality
International
Pseudoephedrine is widely sold as a decongestant.
References
Citations
Further Reading
Article Status
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