- 5 Over-the-Counter Drugs that Get Abused
- 1. Dextromethorphan (DXM)
- 2. Pseudoephedrine
- 3. Loperamide
- 4. Dimenhydrinate
- 5. Diphenhydramine
- Get Help
- Hockey’s Little Helpers
- Pseudoephedrine For Appetite Suppression By Sitesh Patel
- Pseudoephedrine: A Good Appetite Suppressant?
- Diet Pills
- How to Recognize Signs of Diet Pill Addiction
Pseudoephedrine is a drug found in numerous prescription and behind-the-counter medications, including Sudafed Congestion (but not Sudafed PE), Zyrtec-D, and Claritin-D.
It’s used to temporarily relieve nasal congestion from colds, allergies, and hay fever, and temporarily relieve sinus congestion and pressure. Though it can relieve symptoms, pseudoephedrine doesn’t treat or speed the recovery of the underlying health condition.
Pseudoephedrine is in a class of medications called nasal decongestants, which cause smooth muscles around the airway and nasal cavity to relax, allowing more air to flow through. It also causes blood vessels to contract.
Pseudoephedrine is also sometimes used “off label” to treat urinary or stress incontinence, and to prevent ear pain and blockage from pressure changes due to elevation or scuba diving.
Depending on the medication, pseudoephedrine may be paired with other drugs. For instance, the active components of the allergy medication Zyrtec-D are pseudoephedrine and the antihistamine cetirizine hydrochloride. Advil Cold and Sinus contains pseudoephedrine and ibuprofen, a non-steroidal anti-inflammatory drug (NSAID) for pain and swelling.
Numerous drug manufacturers make medicines containing pseudoephedrine, including Pfizer, Acura Pharmaceuticals, and Bayer Healthcare.
Pseudoephedrine “High” and Abuse
Pseudoephedrine is sometimes abused, or used for non-medical purposes, because of its stimulant effects – it can give an excitable, hyperactive feeling and increase heart rate and blood pressure.
The drug has a low risk of dependence, however, and withdrawal symptoms are unlikely to develop after stopping the drug.
Pseudoephedrine has had a controversial history in sports, as some athletes have used it as a performance-enhancing drug – it’s on the World Anti-Doping Agency’s list of substances prohibited during competition.
Pseudoephedrine can be used to make methamphetamine, or meth, a powerful and highly addictive stimulant. For many years, the drug was available over-the-counter (OTC) without prescription or restrictions.
But under the Combat Methamphetamine Epidemic Act of 2005, which was incorporated into the Patriot Act in 2006, pseudoephedrine can now only be sold from locked cabinets or behind the counter – a photo ID is required when purchasing products containing pseudoephedrine, and people are only allowed to purchase a limited quantity of the drug each month.
In 2013, Westport Pharmaceuticals began selling its cold and allergy decongestant Zephrex-D over-the-counter in Missouri pharmacies, because the pseudoephedrine-based medicine had a special formulation that didn’t allow for the easy manufacture of meth.
The Drug Enforcement Administration (DEA), however, quickly released a statement saying the drug could still be used to manufacture meth, and therefore must remain behind the counter with other pseudoephedrine medicines.
You shouldn’t use pseudoephedrine if you are currently taking or have taken within the past two weeks monoamine oxidase inhibitors (MAOIs), a class of antidepressant medications that includes furazolidone (Furoxone), isocarboxazid (Marplan), and phenelzine (Nardil), among other drugs.
Tell your doctor before taking pseudoephedrine if you have or have ever had:
- High blood pressure
- Difficulty urinating, such as from an enlarged prostate
- Thyroid disease
- Heart disease
- Kidney impairment
Also talk to your doctor if you have ever had a narrowing or blockage of your digestive system and plan to take 24-hour extended-release pseudoephedrine tablets.
Don’t give nonprescription products containing pseudoephedrine to children younger than 4 years old, as they may suffer serious side effects, including death. Children under 12 years old shouldn’t be given extended-release pseudoephedrine capsules.
Pregnancy and Pseudoephedrine
Pseudoephedrine is in FDA Pregnancy Category C, which means the risks to the fetus cannot be ruled out, and the benefits of the drug must be weighed against the risks.
Some research suggests that pseudoephedrine use during the first trimester could increase the risk of birth defects. One study, published 2002 in the American Journal of Epidemiology, found that infants had a higher risk of gastroschisis, an abdominal wall defect in which the intestines poke outside the body, if their mothers used pseudoephedrine during pregnancy.
A more recent study published 2013 in the same journal linked pseudoephedrine use during the first trimester to an increased risk of limb-reduction birth defects.
In both studies, however, the overall risks to the unborn child were still very low.
Breastfeeding and Pseudoephedrine
Small amounts of pseudoephedrine are excreted in breast milk, though it’s unclear what effects this has on breastfeeding infants.
A 2003 study in the British Journal of Clinical Pharmacology suggested the drug was unlikely to harm breastfeeding infants. Nonetheless, you should talk to your doctor about taking pseudoephedrine while pregnant or breastfeeding.
5 Over-the-Counter Drugs that Get Abused
There are some substances that are available over the counter, which can, in large enough doses, cause intoxication, a euphoric high, or hallucinations.1,2 Many people may falsely believe that, because these substances are legal and available at places like pharmacies and grocery stores, it is not that dangerous to misuse them. However, the misuse of any substance, even one that can be purchased in your local grocery store, may be dangerous.2
List of OTC Drugs of Abuse
- Dexomethorphan (Robitussin)
- Pseudoephedrine (Sudafed)
- Loperamide (Imodium)
- Dimenhydrinate (Dramamine)
- Diphenhydramine (Benadryl)
Here are five over-the-counter drugs that may be misused:
1. Dextromethorphan (DXM)
This substance is a cough suppressant found in a number of over-the-counter medicines such as Robitussin.1 The drug is commonly found in combination medicines that contain other active ingredients like acetaminophen (Tylenol), antihistamines, decongestants (such as pseudoephedrine), or guaifenesin (an expectorant).1,3 A normal dose of immediate-release DXM is either 10-20 mg every 4 hours as needed or 30 mg every 6-8 hours as needed, not to exceed 120 mg per 24 hours in adults.4
Although some states have banned selling minors over-the-counter medicines containing DXM, the drug is still legal for manufacture, sale, and ingestion in the U.S.5 However, the Drug Enforcement Administration (DEA) lists DXM on its “Drugs of Concern” webpage.6 Though generally safe and effective when taken as directed, it can have serious side effects when misused.7
When DXM is misused, the individual can experience euphoria and hallucinations, typically visual and/or auditory.1 DXM misuse may cause the user to feel disconnected from their body.7They may also experience the following side effects of DXM:7,8
- Increased blood pressure.
- Rapid heart rate.
- Slurred speech.
- Impaired vision.
- Loss of coordination.
DXM may be found in liquid cough syrups, tablets, or capsules. Some people mix liquid forms with soda. Misuse of DXM is sometimes called “skittling” or “robo-tripping.”2
This drug is an active ingredient in many allergy, sinus, cold, and flu medicines, including Sudafed. It relieves the symptoms of nasal and sinus congestion.9
Pseudoephedrine at higher doses may produce stimulant effects, so there is some potential for misuse;10 however, this substance is primarily regulated due to its role in the illicit production of methamphetamine.11
It used to be available over the counter, but now it can only be sold behind the counter, and a person must show their ID. Additionally, there are limits to how much pseudoephedrine a person can buy a month.11
Imodium is one of the brand names for the loperamide, a medication used to control diarrhea, available both OTC and with a prescription.12 Though loperamide is an opioid, it does not usually cross the blood-brain barrier when taken in appropriate doses. It acts on mu-opioid receptors in the intestinal wall and has a hard time reaching the brain to impact the receptors there. This is why loperamide won’t cause opioid toxicity when taken in the appropriate manner.13,14
However, while loperamide is generally safe in directed doses, a growing number of people have been misusing this drug in an attempt to achieve euphoria or relieve opioid withdrawal symptoms.15 There are many discussions on online forums about using loperamide to relieve opioid withdrawal.16 Some people take doses of loperamide that far exceed the recommended doses, which can lead to severe consequences and sometimes death.13
Taking large amounts of loperamide can be very dangerous. It can cause:12,15
- Problems urinating.
- Pupil constriction.
- Loss of consciousness.
- Fast heart rate.
- Irregular heart rhythm (arrhythmia).
- Shallow, slow breathing and/or shortness of breath.
- Cardiac arrest.
If you believe you or someone else may have overdosed, call 911 immediately.
Do You Have Questions About Addiction & Treatment in General?
Explore Our FAQ Guides
Dimenhydrinate, which is often marketed under the brand name Dramamine, is an OTC antihistamine medication taken to prevent or treat motion sickness.17
This motion sickness drug may be misused for its sedative and relaxing effects. In very high doses (about twice the daily maximum dosage), it may induce euphoria and even hallucinations.18
Side effects of dimenhydrinate may include:17
- Dry mouth.
- Hyperactivity (particularly in children).
- Blurred vision.
- Impaired coordination.
- Cardiac changes (faster or irregular heartbeat).
Taking excessive amounts of Dramamine may cause overdose, characterized by symptoms such as:17
- Dilated pupils.
- Flushed face.
- Problems swallowing.
- Trouble speaking.
If you believe you or someone else may have overdosed, call 911 immediately.
This is an antihistamine drug often referred to by the brand name Benadryl.19
This substance may be misused for its stimulant and hallucinogenic effects at high doses. While most people who misuse it will ingest the tablets, some will seek out the gel capsules for injection. Some users will combine it with alcohol or other drugs to heighten the effects.18
According to an article in Pharmacy Times, minors may misuse diphenhydramine, often seeking a sedating effect. However, antihistamines may also cause stimulating cocaine-like effects.20
Possible diphenhydramine side effects, that may be exacerbated with misuse, include:19
- Dry mouth, throat, or nose.
- Lack of appetite.
- Weakness of the muscles.
- Excitement and/or nervousness.
- Impaired vision.
- Painful urination or trouble urinating.
Benadryl overdose signs include:21
- Dilated pupils.
- Low blood pressure.
- Rapid heartbeat.
- Ringing in the ears.
- Blurry vision.
- Difficulty urinating.
While death from diphenhydramine overdose is unlikely if the person receives help quickly, it can cause heart rhythm abnormalities, which may be fatal in some cases.21 If you believe you or someone else may have overdosed, call 911 immediately and provide all the details you know about what drug, or drugs, you or the person you’re with ingested and how much.21
Other Drug Categories
- Abusing Prescription
- Herbal or Plant Based
- Club Drug Abuse
The nonmedical use or any misuse of any medicine is risky, even drugs that can be purchased at your local drugstore. Often, the risks are increased when drugs are combined or when the individual also drinks alcohol while taking the drug. If you have any questions about the safety of a medicine, you should ask your pharmacist or health care provider. Always read the instructions on any medicine you’re taking carefully, and avoid taking larger doses than recommended. If you believe you or someone else may have overdosed, call 911 immediately.
If you or someone you love is struggling with misusing drugs—whether prescription, illicit, or OTC—it’s time to get help. Don’t make the mistake of believing that OTC drug misuse is not dangerous because these drugs aren’t controlled. Serious injury or death could result from the misuse of some of these substances.
Hockey’s Little Helpers
At 6:30 on game nights in Montreal, as the fans start streaming
into the Molson Centre, as the TV sportscasters fidget while
waiting to deliver their live reports, as the hot dogs grill in
the press lounge, Canadiens goaltender Andy Moog goes through
his pregame routine in the dressing room. He takes two Sudafed
tablets and washes them down with a cup of water–it is not a
question of health but of habit. Moog took Sudafed for the first
time six or seven years ago, when he was with the Boston Bruins,
because he had a terrible head cold. Since then, his remedy has
become his ritual. Four other Canadiens also reach regularly for
Sudeys, as they sometimes call them, to kick-start their motors,
to get ready to play. For these men a game face includes an open
mouth and a couple of hockey’s little helpers.
A similar scene is being played out in dressing rooms throughout
the NHL. The exact number of players who use Sudafed, a
nonprescription drug that contains the stimulant
pseudoephedrine, in an effort to boost their performance on the
ice, is unclear. Two NHL trainers estimate that before a game
20% of the league’s players routinely take over-the-counter
medications that contain pseudoephedrine, not to combat the
sniffles, as the manufacturers intended, but to feel a little
buzz. The NHL, however, disputes that figure, saying the
percentage of players using drugs such as Sudafed is much lower
and that they use them for medicinal purposes only.
The brand names vary—pseudoephedrine can be found in dozens of
cold remedies—‚but Sudafed remains the most popular choice for
players who want a pick-me-up. It’s the NHL’s dirty little
secret, and with the Olympics imminent, it is of great concern
to the league because although Sudafed is legal, it is on the
Olympic list of banned substances. Consider the following:
Anecdotal accounts of Sudafed abuse in the league abound. A
former coach says one of his players built up such a tolerance
to the medication that he had to gobble 20 pills to get the
“There are all kinds of overdose stories—guys not being able to
finish the first period because they get the shakes, paranoia,
anxiety,” says Detroit Red Wings athletic trainer John Wharton,
who’s been with the club since February 1991. “There are some
guys who have been able to tolerate . The most I’ve seen a player take is eight
pills. That dose would put some people in the hospital.” Wharton
says he has seen four or five abusers in the last seven years.
Jari Kurri, the respected 17-year veteran right winger of the
Colorado Avalanche, says some of the dirty play in recent years
might be a result of players having had something more than the
usual competitive juices flowing through their systems. He
suggests a link between the use of pseudoephedrine and the
increasing lack of respect NHL players have shown each other in
this decade. “You take it, you get hyped up,” says Kurri, who
also says that he took Sudafed once before a game last season
when he was with the Anaheim Mighty Ducks. “I don’t know if the
stickwork, the dirty hits, are because of that, but I think it’s
something the league should look into.”
Montreal right wing Mark Recchi sees no correlation between
pseudoephedrine and dirty play but doesn’t deny that Sudafed
gets him going. “You get a bit of an upper from it,” says
Recchi, who no longer takes the medication but admits that at
one time he used it every 10 or 15 games. “You get pretty wired
up. Sometimes it gets you a little emotional on the ice, a
little too fired up.”
Brian Savage, a left wing on the Canadiens, takes two Sudafeds
before every game at roughly the same time as Moog. Savage says
he started the routine three years ago, his second season in the
league. “I’m not sure if it pumps me up anymore,” he says,
” if I’m a little groggy, it brings me up.” Sometimes the
trouble is coming down. After a game that ends at about 10:15
p.m., Savage can’t fall asleep until 2 or 2:30 a.m. “I go out
for dinner, have a glass of wine,” he says. “Then I can fall
With the Nagano Olympics scheduled to open on Feb. 7 the abuse
of over-the-counter drugs has become a delicate issue for the
NHL. The league, in its initial Olympic involvement, is
providing players for six Dream Teams for Nagano, and the last
thing it needs is a doping scandal. Sudafed use could lead to
one. The NHL, in conjunction with the players’ association,
tested prospective Olympians during training camps and has
continued with random testing during the season in hopes of
preventing the embarrassment of a failed test at the Games. In
Nagano a positive drug test after a game by a player would
result in the suspension of that player from the Olympics and in
his team’s forfeiting that game. If a player tested positive
after a medal-round game, he and his teammates could be stripped
of their medals.
An IOC drug-testing official told SI that if a person ingested a
small quantity of pseudoephedrine—the normal dosage in two
regular-strength Sudafed pills—traces of the stimulant could
show up in his urine sample up to a month later. However, the
official said that “after about a week” it was unlikely that
enough would show up to produce a positive result.
Still, NHL Olympic participants and trainers are taking no
chances with Sudafed and its chemical cousins. The Canadiens
have changed their protocol for the distribution of
over-the-counter cold remedies this season, requesting that
players get them only from the medical room even though anyone
can pick up a box of 24 Sudafed extra-strength decongestant—one
of eight Sudafed brands marketed in Canada—for $6.99 at a
pharmacy. (Last week one Montreal player had a bottle containing
Sudafed tablets on a shelf in his locker.) Several Olympians,
including New Jersey Devils goaltender Martin Brodeur and
Colorado right wing Adam Deadmarsh, haven’t taken the medication
even to fight winter colds this season because of the
approaching Games, according to newspaper accounts and team
sources. Wharton says, “We’ve been super cautious with Yzerman and Shanahan for
The impish Shanahan, though, was less circumspect in a Jan. 18
interview with TSN in Canada. When asked if he enjoyed teaming
with U.S. players on the North American squad in the All-Star
Game, he cracked that it gave him an opportunity to “see if
anybody’s popping Sudafeds in the American drinks.”
Shanahan was joking, but the casual approach to over-the-counter
medications is no laughing matter. The effects of
pseudoephedrine are similar to what Canadian Olympic team doctor
Eric Babins calls its “first cousin”—adrenaline, or
norepinephrine: It can increase breathing capacity by shrinking
and unblocking nasal passages and dilating the bronchial
passages while raising the heart rate and blood pressure. The
drug stimulates the sympathetic nervous system, which controls
involuntary muscles and responses, including the fight-or-flight
response so critical in the wild. Players who have used Sudafed
say that if they take the medication an hour before a game, they
begin to notice its effects 35 or 40 minutes later, during
warmups. Doctors say pseudoephedrine is at its most potent about
two hours after it is taken, although the drug remains active in
the system from eight to 16 hours, depending on the dosage, the
formulation and the individual. Potential side effects include
tremors and anxiety, but there appear to be no long-term effects
unless the user already has a cardiac condition. While the pills
may not be physically addictive, the high that the players get
from the medication is.
According to players and medical personnel, Sudafed began to
appear in NHL dressing rooms in the mid-to-late 1980s. The
approach to the medication at the time was surprisingly relaxed
on some teams. When Wharton joined the Red Wings as their
strength and conditioning coordinator, he says, Sudafed tablets
sat on the table in the dressing room “like a bowl of fruit. But
we got rid of them right away.” He estimates that three quarters
of the Detroit players at the time used Sudafed before a game.
The use of Sudafed probably crested three or four years ago, not
long after the issue of over-the-counter medication was
discussed at a meeting of the NHL Physicians Society. “There was
a concerted effort among the doctors at the time to tell players
that was not a good idea,”
says Terry Groves, the Calgary Flames’ team internist since
1980. In the early 1990s, Groves says, a notice was posted in
the Calgary dressing room that cold remedies, specifically
Sudafed, would not be dispensed by the trainers. He says he sees
no current evidence of Sudafed use by Flames players.
“We’re trying to get across our message,” says Gaetan Lefebvre,
the Canadiens’ athletic trainer, who keeps a card handy listing
all the over-the-counter medications proscribed by the IOC.
“Those medications are for medical purposes. If you’re looking
for an edge, try getting it by working out in the gym.”
But if the message about misusing Sudafeds is being spread, not
all NHL players are listening. Some have merely abandoned
Sudafed for other legal products that provide the same boost.
Players are using various alternatives—including Up Your Gas
tablets—that contain the Chinese herb Ma-Huang and are
available at health-food stores. “Some of the younger players
are taking a more holistic, natural approach,” Moog says of the
switch from Sudafed to a naturally occurring form of ephedrine,
a stimulant with properties similar to pseudoephedrine, which
also could produce a positive drug test at the Olympics.
Even a squeaky-clean Olympics will not mask the fact that
hockey’s little helpers are part of the NHL scene. They might
not be the thinking man’s choice—”Guys don’t need it if they’re
healthy in their ,” says Red Wings center Igor
Larionov—but they are an option.
COLOR PHOTO: BURK UZZLE COLOR PHOTO: DIGITALLY ENHANCED PHOTO BY AL BELLO/ALLSPORT “You get pretty wired up. Sometimes it gets you a little emotional on the ice, a little too fired up.” Back to Top
Pseudoephedrine For Appetite Suppression By Sitesh Patel
Pseudoephedrine: A Good Appetite Suppressant?
Bodybuilders, dieters and athletes are always on the look out for that one compound that will help them reach their physical goals. The market is a very complex one. With the supplement industry not requiring FDA approval on their products, compounds are being released for every niche and purpose without any true studies done for safety or efficacy. Diet aids seem to have the biggest advantage for this with the ability to take advantage of those people who are looking for anything out there that can help them shed those extra 10-15 pounds. With new Jamaican Jambalayan derived Hoodia products being released, people are starting to forget products that already exist in the marketplace which have already been proven to be safe and efficacious.
A pharmaceutical product which has gained much popularity as of lately, however not in a good way, is Pseudoephedrine. Pseudoephedrine, being FDA approved as an over-the-counter oral decongestant, is closely related to the once powerful weight loss supplement ephedrine. The truth was ephedrine (and its ephedra alkaloids) worked. It not only promoted thermogensis in humans, but was a potent appetite suppressant. Unfortunately today, ephedra is not an easy compound to obtain. It is scarcely available as an OTC pharmaceutical, used as a bronchodilator, and in some states is still available as an herbal product. Pseudoephedrine on the other hand is still widely available in the U.S., and even though it does have some restrictions, it can still be obtained with quite ease. In this article we will discuss the pharmaceutical properties of pseudoephedrine, restrictions on its purchase, and its use as an appetite suppressant.
Pseudoephedrine is a sympathomimetic amine and a (1S,2S)- diasteromer of ephedrine. It is available over-the-counter as a decongestant and is commonly found in combination with other medications (ie. antihistamines, cough and cold preparations). Being a sympathomimetic amine, it stimulates the sympathetic nervous system by displacing norepinephrine from storage vesicles in presynaptic neurons to activate postsynaptic adrenergic receptors. Pseudoephedrine is also an ?1a, ?2a and ?2-receptor agonist. By selectively activating the alpha receptors in the mucosa tract of the respiratory and nasal pathways, pseudoephedrine produces vasoconstriction shrinking membranes and relieving congestion. Activation of the beta2 receptor causes bronchodilation, which is relaxation of the bronchial smooth muscle, which allows the user to breathe easier. Pseudoephedrine has less pressor activity and a lower affinity for the central nervous system when compared to ephedrine so one should not to see much, if any, of a stimulating effect at recommended doses.
Pseudoephedrine is readily absorbed from the GI tract with very little first pass metabolism. It is excreted mostly unchanged in the urine with few metabolites from being metabolized hepatically. The half-life is approximately 4-6 hours being dependant on urinary pH. If urine pH is less than 6 then the half-life may be decreased, as opposed to being increased when the urine pH is greater than 8. Pseudoephedrine has also been shown not to bind to plasma protein when the concentration is between 50-2000ng/mL.
Pseudoephedrine is commonly used for the following:
- Relief from nasal or sinus congestion;
- Relief of ear congestion;
- Treatment of vasomotor rhinitis (non-allergic rhinitis); and
- First line treatment for Priapism (erection lasting more then four hours)
Potential ADR’s are as follows:
- CNS Stimulation
- Elevation of blood pressure
Few events have been reported of hallucinations and stroke, similar to ephedrine.
Pseudoephedrine should not be used if you are currently taking an MAO-I or any anti-hypertensive medications (i.e. beta-blockers).
Pseudoephedrine is available in different strengths and dosage forms. The most popular OTC version is the 30mg tablet. Normal dosing on this is one 30mg tablet, every four hours. Also available are extended-release tablets in 120mg and 240mg. The 120mg tablet should be dosed one tablet every 12 hours and the 240mg tablet should be taken only once a day. The maximum advised dose for pseudoephedrine is 240mg per 24 hours.
Restrictions on Purchase
With the recent increase in illicit methamphetamine use, pseudoephedrine is being sought after by ‘home cooks’ to use in meth production. Since its availability was once quite easy and the synthesis could be completed on kitchen stoves, the government had to step in and limit the sales of pseudoephedrine in an effort to limit illegal methamphetamine production. Currently, only pharmacies are allowed to sell pseudoephedrine and it must be kept behind the counter. For each purchase, the customer must present a government issued photo ID and it must be recorded in a computer or a log book. The government has also limited the amount of pseudoephedrine that could be purchased per day and per month. Individual purchases are limited to 3.6 grams per day, and no more then 9 grams being purchased within a 30-day period. While this does limit the amount that you can experiment with, a user will still be able to consume 300mg of pseudoephedrine a day.
Pseudoephedrine as a Diet Aid
Alright well now on to the fun stuff. Sympathomimetic stimulants have long been used clinically as appetite suppressants for the short-term treatment of obesity (ie. Phentermine). Hypothalamic appetite centers in the brain control both central and peripheral signals. This center can be turned on and off by the use of anorectic agents which includes noradrenergic, serotonergic, and dopaminergic drugs. Pseudoephedrine, ephedrine, and phenylpropanolamine (norephedrine) all increase norepinephrine adrenergic neurotransmitter concentrations thus activating hypothalamic centers, which results in decreased appetite and food intake. They do this by stimulating the excitatory alpha-1 and beta-2 receptors which suppress appetite; stimulation of the inhibitory alpha-2 receptor on the other hand will actually work to increase appetite.
Pseudoephedrine may not be as strong as ephedrine or PPA, however it does work. Tolerance, just as with any other stimulant, is a strong possibility so it would be best if the drug was cycled. The most efficacious dosing is to take one 120mg extended-released tablet, twice a day, or one 240mg extended-released tablet per day. One could also take 30mg tablets spread throughout the day however anecdotal reports have said for this not to be as effective as using the extended-release form.
‘Stacking’ or combining pseudoephedrine with other products may work to increase it efficacy. Caffeine is a competitive inhibitor of the enzyme cAMP-phosphodiesterase which metabolizes cyclic AMP (cAMP) to its non-active form. One mechanism behind how norepinephrine works is that it increases the levels of cAMP. Thus by consuming caffeine along with the pseudoephedrine it can help not only to prolong, but also intensify, the effect of norepinephrine. One could start out with 100mg of caffeine twice a day, and gradually work up to 200mg twice a day. However with the amount of caffeine people are consuming now-a-days tolerance may already be a bit high and 100mg may not have much of an effect.
Tolerance should be assessed by starting at a lower dose of pseudoephedrine before increasing it due to the fact some people notice an increase in heart-rate, blood pressure, and even some neuropsychiatric effects (hallucinations). A dosing scheme should be tailored to your tolerance, here is an example:
Week 1: 120mg pseudoephedrine once a day with 100mg caffeine twice a day
Week 2: 240mg pseudoephedrine once a day (or 120mg twice a day) with a 100mg caffeine twice a day.
Week 3-6: 240mg pseudoephedrine once a day (or 120mg twice a day) with 200mg caffeine twice a day.
Cycle off for 2 weeks and repeat.
In conclusion, I hope that this article will start generating more feedback on the use of pseudoephedrine as an appetite suppressant. As long as you are a responder, this should be an efficacious and safe product to add to your dieting needs. On top of that, it will allow you to breathe easier while working out! If you have any questions or feedback please email me at . I would love to hear them.
1. Lacy CF, Armstrong L, Goldman M, Lance L, editors. Drug Information Handbook, 11 th ed. Canada: Lexicomp; 2003.
2. Stauffacher W. Mode of action and indication for appetite depressants in the treatment of obesity. Schweiz Med Wochenschr. 1975 Apr 12;105(15):461-6.
3. Drew CDM, Knight GT, Hughes DTD, et al. Comparison of the effects of D-(-)-ephedrine and L-(+)-pseudoephedrine on the cardiovascular and respiratory systems in man. Br J Clin Pharmacol 1978;6;221-225.
4. Chairman Jackson-John. Pseudoephedrine Restrictions Effective July 1st. New Mexico State Board of Pharmacy. June 14, 2006.
5. Hoffman, BB.; Lefkowitz, RJ. Catecholamines, sympathomimetic drugs, and adrenergic receptor antagonists. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon W, Gilman AG. , editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw Hill; 1996. pp. 199–248.
6. Dulloo AG. Ephedrine, xanthines and prostaglandin-inhibitors: actions and interactions in the stimulation of thermogenesis. Int J Obes Relat Metab Disord. 1993;17(suppl 1):35–40.
Author: Chris Elkins, MA | Last Updated: 30-Jan-2020 | 29 sources
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How to Recognize Signs of Diet Pill Addiction
Individuals with behavioral addictions or drug addictions engage in compulsive behaviors despite negative consequences. If someone is physically dependent on a diet pill, they may take it to avoid withdrawal.
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AuthorChris Elkins, MA, Senior Content Writer, DrugRehab.com Chris Elkins worked as a journalist for three years and was published by multiple newspapers and online publications. Since 2015, he’s written about health-related topics, interviewed addiction experts and authored stories of recovery. Chris has a master’s degree in strategic communication and a graduate certificate in health communication. @ChrisTheCritic9
Pseudoephedrine has been around since the 1920s. Although the drug occurs naturally in certain plants (eg, ma huang), the majority that is produced derives from yeast fermentation of dextrose in the presence of benzaldehyde. Pharmaceutical manufacturers in China and India produce the bulk of commercially available pseudoephedrine.
MECHANISM OF ACTION
Pseudoephedrine is a sympathomimetic drug belonging to the phenethylamine and amphetamine chemical classes. Its principal mechanism of action depends on its effects on the adrenergic receptor system, causing vasoconstriction. Pseudoephedrine hydrochloride and its sulfate salts are found in an abundance of over-the-counter medications, either as a single ingredient or in combination with other ingredients, such as anti- histamines, acetaminophen, guaifenesin, nonsteroidal anti-inflammatory drugs, and dextromethorphan.1
The most common indication for pseudoephedrine is as a decongestant, for conditions including nasal congestion, sinus congestion, and eustachian tube congestion, as it shrinks swollen nasal mucous membranes and reduces tissue hyperemia and edema.2 Other uses include vasomotor rhinitis, first-line treatment for priapism, and off-label use for hyperprolactinemia, while veterinarians often use pseudoephedrine off-label to treat incontinence in dogs and cats.2 In conjunction with other medications, pseudoephedrine is often used to treat allergic rhinitis, croup, sinusitis, otitis media, and tracheobronchitis.1
Some adverse effects of pseudoephedrine that typically do not need medical attention and that may subside during use include nervousness, restlessness, and trouble sleeping. Less common are dysuria, syncope, tachycardia, palpitations, headache, nausea and vomiting, trembling, and weakness.3
Pseudoephedrine is contraindicated in patients with type 2 diabetes, as it may increase glucose levels.4 Patients with glaucoma or a predisposition for glaucoma should not use pseudoephedrine because of its vasoconstrictive qualities.4 The same is true for prostatic hypertrophy4. Pseudoephedrine may worsen the following conditions: cardiovascular disease, severe or uncontrolled hypertension, severe coronary artery disease, ischemic heart disease, and hyperthyroidism.4
Some products may interact with pseudoephedrine, including terbutaline and stimulants, such as caffeine, dextroamphetamine, and herbal products including ephedra and ma huang.5 Taking tricyclic antidepres- sants or monoamine oxidase inhibitors (MAOIs) with pseudoephedrine may cause a potentially fatal drug interaction called hypertensive crisis.5 Some MAOIs should be discontinued for 2 weeks prior to pseudoephedrine treatment.5 Finally, pseudoephedrine may reduce the effectiveness of certain antihypertensives, including beta-blockers and calcium channel blockers.5
Pseudoephedrine has a pregnancy category of B.6 Some research has shown a possible link to birth defects when pseudoephedrine is taken within the first trimester of pregnancy.7 Although it is not known whether pseudoephedrine crosses the placenta, some think that its vasoconstrictive property of reducing blood flow to the uterus may be responsible for the defects when the drug is taken in the first trimester.
Pseudoephedrine is excreted in breast milk in small amounts. Fully breast-fed infants whose mothers took a full 60-mg dose of pseudoephedrine would receive between 2.2% and 6.7% of the maternal weight-adjusted dose.8 In 1 study, mothers reported irritability and/or agitation in about 20% of infants who were breast-fed after the mother ingested pseudoephedrine. The most significant adverse reaction to taking pseudoephedrine while breast-feeding is a decrease in milk production. A single dose of pseudoephedrine can significantly reduce milk production, and continued use could upset lactation,9 hence its off-label use for hyperprolactinemia.
Oral forms of pseudoephedrine are readily absorbed from the gastrointestinal tract and excreted principally unchanged in the urine. A small amount is metabolized in the liver and also excreted in the urine. The half-life of pseudoephedrine is between 5 and 8 hours, though the more acidic the urine, the lower the half-life.10
Pseudoephedrine can be illegally used to manufacture methamphetamine, which has become a national epidemic. The Combat Methamphetamine Epidemic Act of 2005 was incorporated into the Patriot Act on March 9, 2006, by President George W. Bush. This law bans over-the-counter sales of medications containing pseudoephedrine, so these products must be sold from locked cabinets or behind the pharmacy counter.11
The law also limits the amount of pseudoephedrine that a person can purchase daily (3.6 g) and monthly (9 g).12 Patients purchasing must present valid photo identification. Sellers are typically required to keep the name of the product, quantity sold, name and address of purchaser, the date and time of the sale, and the purchaser’s signature for a minimum of 2 years after the sale.12 Some states require that the seller be a pharmacist or a pharmacy technician. Check with your state board for clarification.12
Since the implementation of the Combat Methamphetamine Epidemic Act, it has been difficult to obtain pseudoephedrine for the general public, but the methamphetamine epidemic has just continued to grow. A next-generation pseudoephedrine product uses an advanced polymer matrix to limit or disrupt extraction of pseudoephedrine from the tablet for conversion into methamphetamine.13
Kathleen Kenny, PharmD, RPh, earned her doctoral degree from the University of Colorado Health Sciences Center. She has 20-plus years’ experience as a community pharmacist and works as a clinical medical writer based in Colorado Springs, Colorado.