Pseudoephedrine

Pseudoephedrine is a sympathomimetic medication which is used as a nasal decongestant to treat nasal congestion. It also has many off-label uses, such as treatment of hypotension (low blood pressure). At higher doses, pseudoephedrine acts as a psychostimulant, appetite suppressant, and performance-enhancing drug; as a result, non-medicinal use of pseudoephedrine is common, and it is often considered an abused drug. The medication is administered orally. Pseudoephedrine is sold under many brand names, Sudafed being among the most common. Side effects of pseudoephedrine include insomnia, elevated heart rate, increase in blood pressure, psychomotor agitation and restlessness, dizziness, anxiety, and dry mouth. Rarely, pseudoephedrine has been associated with serious cardiovascular complications like heart attack and hemorrhagic stroke. Some people are more sensitive to its cardiovascular effects than others. Pseudoephedrine acts as a norepinephrine releasing agent, indirectly activating adrenergic receptors. As such, it is an indirectly acting sympathomimetic. Pseudoephedrine significantly crosses the blood-brain barrier, but has some peripheral selectivity due to its hydrophilicity. Chemically, pseudoephedrine is a substituted amphetamine and is closely related to ephedrine, phenylpropanolamine, and amphetamine. It is the (1S,2S)-enantiomer of β-hydroxy-N-methylamphetamine. Along with ephedrine, pseudoephedrine occurs naturally in ephedra, which has been used for thousands of years in traditional Chinese medicine. It was first isolated from ephedra in 1889. Subsequent to its synthesis in the 1920s, pseudoephedrine was introduced for medical use as a decongestant. Pseudoephedrine is widely available over-the-counter (OTC) in both single-drug and combination preparations. Availability of pseudoephedrine has been restricted starting in 2005 as it can be used to synthesize methamphetamine. Phenylephrine has replaced pseudoephedrine in many over-the-counter oral decongestant products. However, oral phenylephrine appears to be ineffective as a decongestant. In 2023, pseudoephedrine was the 292nd most commonly prescribed medication in the United States, with more than 400,000 prescriptions. In 2023, the combination with brompheniramine and...