What is pseudoephedrine and is it OK to take it a lot?

9:18 am on 29 May 2024
A person about to consume cold medications with a cup of tea

Do you know what's in over-the-counter cold and flu medicines? Photo: Getty Images / Unsplash

Explainer - Flu season is in full swing and many have been hit with head-colds and sore throats already.

As we approach winter and peak sickness season, Kiwis will be flocking to pharmacies for over-the-counter cold and flu medicines - especially those containing pseudoephedrine.

Here's everything you need to know before you go and buy.

What is pseudoephedrine?

Pseudoephedrine is a decongestant that can be used to treat stuffy noses and relieve sinus pressure. It's an active ingredient used in many cold and flu medicines, such as Nurofen Cold & Flu, or Sudafed.

In 2011, pseudoephedrine was banned from being sold over the counter for fear it would be used in methamphetamine production. In the years since, medicines containing pseudoephedrine had effectively become unavailable in New Zealand.

Peudoephedrine has now returned to New Zealand shelves under the National, ACT, NZ First coalition government. It can now be purchased from pharmacies without a prescription.

What are the alternatives to pseudoephedrine?

Nasal sprays are readily available at supermarkets. But while these work well to reduce congestion over the short-term, long-term use can result in damage to the nasal lining, and ceasing use altogether can have a rebound effect causing more congestion.

Over the years there has also been a big conversation over phenylephrine, a drug touted to do exactly the job pseudoephedrine can. However, University of Auckland pharmacy lecturer Dr Rhys Ponton disputed this in a 2023 interview with RNZ's The Detail.

"We saw that the FDA announced the results of a review they've conducted which has confirmed what we already knew, in that phenylephrine really is not effective as a decongestant."

A box of tissues and some cold medicine

Decongestants help you feel better by unblocking nasal passages and relieving sinus pressure. Photo: Diana Polekhina / Unsplash

Why is pseudoephedrine so good at making you feel better when you have a cold?

You experience a blocked or stuffy nose when the blood vessels in the cavities of your nose (sinuses) become swollen. Pseudoephedrine works by reducing this swelling, and that helps mucus and air flow more freely.

Many people also report a pleasant feeling throughout their body once they take their meds. This is because pseudoephedrine increases the release of serotonin and dopamine (our happy chemicals).

Can it be bad for you?

Like all medicines, pseudoephedrine comes with a set of risks. Restlessness, nausea and difficulty sleeping are common side effects, while headaches, increased sweating, and painful urination are less common.

When used properly, pseudoephedrine is not addictive, but when it's abused, it can be harmful. The most common misuse of pseudoephedrine is when it's converted into an ingredient that is used to make meth and 'bath salts' (psychoactive drugs similar to cocaine or MDMA). Some people may also misuse it as an illegal stimulant to increase alertness or enhance physical performance.

A sick person wrapped in a rug about to blow their nose

Dealing with winter ills requires a mix of modern medicine and old-fashioned common sense. Photo: Kateryna Hliznitsova / Unsplash

Who shouldn't take it?

Pseudoephedrine isn't suitable for everyone, and while medicines containing it are now available over the counter, you will only be able to buy them following a consultation with a New Zealand-registered pharmacist.

If you have high blood pressure, diabetes, an overactive thyroid gland, glaucoma, or heart disease, you might be better off without it.

Pseudoephedrine is also more likely to cause side effects in infants, especially newborns and premature infants, than in older children or adults.

Does it help with Covid-19 symptoms?

Pseudoephedrine can help alleviate milder symptoms of Covid-19, like congestion or a runny nose. But other overlapping symptoms like body aches or sore throats are better treated with over-the-counter pain relievers like ibuprofen or acetaminophen.

What else should you do when you have a winter lurgy?

All the usual advice your grandma gives you actually checks out.

Get plenty of rest to help your body recover, prioritise nutrition to boost your immune system, and stay hydrated - water, juices, herbal teas and broths all help to prevent dehydration, which can worsen symptoms. Te Whatu Ora says to take fever reducers (like paracetamol or ibuprofen) and use honey or lozenges to sooth a sore throat and keep monitoring your symptoms.

When taking your meds, Healthify suggests you follow the directions on labelling carefully, as different cold and flu medicines have different doses, depending on the product. Capsules, tablets, liquid and powder meds aren't always taken the same way - the packaging will tell you how much to take, how often to take it, and any special instructions.

Another pro-tip is to use a humidifier in your room - this will ease respiratory symptoms.

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