Pseudoephedrine is a common over-the-counter decongestant medication used in the treatment of colds, hay fever, and the flu. It is also used in the manufacture of some illicit substances.
This article will explain what pseudoephedrine is, how it’s used, the risks of misuse, and how to get help if you or someone you care about is struggling with a substance use disorder.
What Is Pseudoephedrine?
Pseudoephedrine is a substance that naturally occurs in the plant Ephedra sinica, which is referred to as ma huang in traditional Chinese medicine. The substance is chemically related to amphetamine and often used in the illicit production of the central nervous system stimulant methamphetamine (crystal meth).
It is found in many over-the-counter medications, such as Sudafed, Sinutab, Allegra-D, and Claritin-D. The drug has also been used to enhance athletic performance and may be banned by many professional athletic associations.
Because it has been recognized as an ingredient that is used in the illegal production of methamphetamine and methcathinone (a chemical often used in the production of bath salts), pseudoephedrine is subject to controls and monitoring by the United States Drug Enforcement Administration. Despite this, it is not listed as a controlled substance.
The major concern regarding misuse of pseudoephedrine is the ease with which it can be manufactured into more powerful stimulants such as methamphetamine. In order to mitigate this risk, federal law limits the amount of pseudoephedrine any person can buy at one time. It also requires that purchasers produce a photo ID and that retailers keep records of sales of this drug for a minimum of two years.
How Does Pseudoephedrine Work?
Pseudoephedrine and its sister drug ephedrine are classified as sympathomimetic amines, meaning that they have stimulant-like effects that increase the activity of the cells in the sympathetic nervous system, part of the peripheral nervous system that is associated with controlling the fight-or-flight mechanism.
These drugs also reduce the effects of nasal congestion and can be used as appetite suppressants. Both pseudoephedrine and ephedrine were at one time the main ingredients in many over-the-counter dietary supplements.
Unaltered pseudoephedrine is a drug that has been misused by individuals, mostly younger folks, due to its over-the-counter availability. When individuals can get their hands on a sufficient amount of the drug, they can use it to experience its stimulant-like effects, such as:
- Increased feelings of energy and alertness.
- Extreme euphoria and wellbeing.
- A pleasant tingling sensation over their bodies.
These effects do not occur at the recommended medicinal levels of the drug, but can only occur when individuals use significant amounts of the drug and snort it or even mix it in liquid and inject it.
Because of controls placed on the purchase and sale of pseudoephedrine, misuse is relatively rare. However, signs of cold medicine misuse include:
- Red eyes.
- Dilated pupils.
- Increased energy.
- Loss of appetite.
- Difficulty sleeping.
- Unexplained weight loss.
Side effects associated with pseudoephedrine misuse include:
- Increased thirst.
- Dry mouth.
- Muscle weakness.
- Tightness in the chest.
- Increased blood pressure.
- Irregular heartbeat.
- Tremors, in extreme cases.
- Potential seizures.
- Nausea, vomiting, and/or diarrhea.
At high doses, individuals may develop signs associated with amphetamine use, such as high blood pressure, sweating, increased heart rate, and psychiatric symptoms like paranoia and hallucinations.
As with most stimulant substances, tolerance to pseudoephedrine most likely develops rapidly. Based on the diagnostic criteria for stimulant withdrawal put forth by the American Psychiatric Association, some individuals who chronically misuse the drug and then suddenly discontinue its use could likely experience issues with:
- Negative mood states like depression, anxiety, apathy, and irritability.
- Extreme lethargy and sleepiness.
- Increased appetite.
- Vivid dreams that are unpleasant.
- Problems with nasal congestion.
- Cravings for the drug.
Treating Pseudoephedrine Misuse
There is no formal withdrawal management protocol associated with recovery from the misuse of pseudoephedrine or cold medicines. Treatment generally involves the specific needs of the individual and follows the overall general principles associated with the effective treatment of substance use disorders. These principles have been outlined by the National Institute on Drug Abuse (NIDA) and would include:
- Making sure that the person gets treatment immediately.
- Treating any co-occurring mental health issues along with the person’s substance use disorder.
- Getting family members involved in the individual’s recovery process.
- Ensuring that the individual remains in treatment for a sufficient length of time.
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