Pseudoephedrine

Pseudo means false or untrue, as in “pseudointellectual,” a name for someone who is really not very smart.  The “fed” part of the word is taken from the plant, Ephedra,  a naturally occurring alkaloid.  If you look closely at the fine print on the bottle it will say pseudoephedrine HCL.  Pseudofed is a common drug in many over the counter sinus medications and it is usually packaged with a non-narcotic analgesic like aspirin or Tylenol.  A typical example would be Sinutab which is pseudofed and Tylenol.  Pseudofed causes vasoconstriction of the small blood vessels in the nose and thereby acts as a decongestant.  The extremely vascular nasal mucosa shrinks in response to this vasoconstricting lack of blood flow, and opens the nasal passages.  The patient breathes again. The advantage of the drug is that it produces a gradual but sustained decongestant effect, causing little “rebound” congestion.  Although it exerts a sympathomimetic effect, it does it indirectly.  It is better for the nose to get a decongestant orally, through a pill, than by directly putting something in the nose, such as Afrin nasal spray, which typically causes decongestant rebound if used more than a few days.

Pseudofed has rather common and unwanted side effects.  These are also usually listed on the bottle in small print, namely: anxiety, irritability, an elevation of mood, mental alertness, increased systemic blood pressure, insomnia, and decreased appetite.  With continued use and especially at high doses, tolerance to the medication develops and as the user increases the dosage, toxic signs and symptoms may occur.

Pseudofed is often appended to antihistamine medication.  It is the D, or Decongestant implied in Claritin (loratadine-D. The antihistamine works on the altered immune function giving the allergy symptoms and the Decongestant, pseudofed, causes nasal arterial constriction.  This sneaks up on some people who don’t realize what their doctor has ordered and they find that they can sleep fine on plain Claritin (loratadine), but they can’t when they get Claritin (loratadine)-D.

Another problem exists for anxious or panic attack patients who may become more agitated on pseudofed, which acts in a lot of ways like caffeine.  Patients with tremor, either Parkinson’s Disease or Benign or Familal Tremor, may find their shaking is worse if they take pseudofed.  Patients with “sinus headache,” which 80 % of the time is really Migraine, may find that their headache gets better after they take an over the counter medication which contains a pain killer and pseudofed.  The true story is that their migraine headache, caused by vasodilatation of arteries in the brain, is better following the vasoconstrictor effect of pseudofed.

Pseudofed has a stormy side also.  It has been on a recent FDA newsletter alert sent to physicians because of its habituating qualities.  Drug addicts, operating home meth labs, often buy up large doses of pseudofed and then change it to methamphetamine, a structurally similar chemical.  The pseudofed industry has misled the American population since the 1950’s with TV ads on “Sinus Headache.”  The International Classification of Headache Disorders 3 Beta doesn’t recognize “Sinus Headache” which is usually migraine.  Read my article on Sinus Headache.