Pseudoephedrine - safety and efficacy?

I have used an ECA product for years.

I have to be honest I have had a couple of close calls in those years and I have known people that have died from use.

It all comes back to "each of us responds differently" scenerio.
What our current condition, such as, family inherited blood pressure problems (me) or other heart related conditions as to whether we can tolerate these medications or supplements.

I currently use the current products that are "Ephedra Free".
They use caffiene and bitter orange (synephrine) which has a similiar effect as ephedra, but deffinately not as strong or as dangerous. Ephedra, PSE, or Ephedrine can be unpredictable IMO because once you find that you are tolerant and have built up a tolerance like caffiene it can still have unpredictable moments. Out of the blue you can have a bad episode when the heart begins to race and for some people they have heart failure during those moments.

I use these products for exactly why you stated in that I seem to have constant year round congestion in my sinus, but the new ephedra free products containing bitter orange still help me a bit with this issue. I stick to an early morning dose only. It does well because it gets me up and ready to workout and also clears my head to some degree. Again not quite as effective as ephedrine based products, but safer it seems.

The studied recommended ECA stack is:
25 mg ephedrine, 250 mg caffiene, 80-300mg asprin

It is always recommended to start on the lower side as a test and build up, but go no further than the described stack above. Those who have died probably used higher doses or had pre existing heart conditions.

I better throw in a word of caution about the bitter orange.
Even though I have never had a negative incident it does seem to garner some warnings from others.

forces.gc.ca1 05 synephrine e.aspOpen ↗

medicalnewstoday.commedicalnews.phpOpen ↗

chppm-www.apgea.army.milBitter%20Orange.pdfOpen ↗

mayoclinicproceedings.cominside.aspOpen ↗=

Felt_Rider said:

I have used an ECA product for years.

I have to be honest I have had a couple of close calls in those years and I have known people that have died from use.

It all comes back to "each of us responds differently" scenerio.
What our current condition, such as, family inherited blood pressure problems (me) or other heart related conditions as to whether we can tolerate these medications or supplements.

I currently use the current products that are "Ephedra Free".
They use caffiene and bitter orange (synephrine) which has a similiar effect as ephedra, but deffinately not as strong or as dangerous. Ephedra, PSE, or Ephedrine can be unpredictable IMO because once you find that you are tolerant and have built up a tolerance like caffiene it can still have unpredictable moments. Out of the blue you can have a bad episode when the heart begins to race and for some people they have heart failure during those moments.

I use these products for exactly why you stated in that I seem to have constant year round congestion in my sinus, but the new ephedra free products containing bitter orange still help me a bit with this issue. I stick to an early morning dose only. It does well because it gets me up and ready to workout and also clears my head to some degree. Again not quite as effective as ephedrine based products, but safer it seems.

The studied recommended ECA stack is:
25 mg ephedrine, 250 mg caffiene, 80-300mg asprin

It is always recommended to start on the lower side as a test and build up, but go no further than the described stack above. Those who have died probably used higher doses or had pre existing heart conditions.

Ephedrine is banned so I would never use it.

Going back to your original question of safety.

Pseudoephedrine or ephedrine can have the same exact adverse effects and the same bronchodialator effects. Both are extracts from ephedra.

Just stating that if you want to find toxicity levels doing a Google search for pseudoephedrine will normally show ephedrine in the topic. They are considered the same for toxicity levels as far as I know, but I could be wrong.

The following link has more information regarding the two.

pubmedcentral.nih.govarticlerender.fcgiOpen ↗

Roadie_scum said:

Ephedrine is banned so I would never use it.

No it isnt...... at least im 95% sure it isnt anymore.

I used it for weight lose (very effectivly) BUT one thing you may wish to consider..... if you use it in a race be very aware of your HR. I got carried away in a race and went hard up a hill to stay in contact, got close to max hr and nearly blacked out.... I spoke to my Doc and he suggested thermagenics and max HR should not really be mixed.

Not being a competitive cyclist, but being fairly knowledgeable in sports supplements and various PED's I do not understand why cyclist would add in stimulants now for the very reason that Fixey just stated.

I didn't understand this at first, but lately I have noticed my worst rides are when I have too much caffiene or other stimulants like the bitter orange.

On those days my heart rate is high even during a light warmup and when I begin to push for intervals I cannot push hard because my heart rate sky rockets immediately and then I cannot recover unless I pull to the side and rest until it comes back under control. Bad enough that a slow pace my heart rate will not calm down unless I pull to the side.

I count this as something perhaps individual to me, but it seems like this would have at least some impact even to those who do not have a heart rate problem. The guy that I ride with does not seem to be affected by the caffiene he drinks before a ride.

I have learned that stimulants are a bad thing for me personally as far as cycling or interval training.

Fixey said:

No it isnt...... at least im 95% sure it isnt anymore.

If you don't know... check!

Section 6 of the WADA prohibited substances list states that each of ephedrine and methylephedrine is prohibited when concentrations reach 10 micrograms/liter in urine. It also states that pseudoephedrine is not a prohibited substance but is on the monitoring list.

You can find the list at: http://www.wada-ama.org/en/dynamic.ch2?pageCategory_id=47

Roadie_scum said:

PSE is currently legal under the WADA code, though its metabolites may return a positive test for norPSE in high dosages. There is limited data suggesting an ergogenic effect for PSE in combination with caffeine, but none that I'm aware of for PSE by itself. I have heard suggestions from cardiologists and other doctors that PSE increases risk of adverse cardiac event and would guess that any risk would be magnified whilst exercising, especially if becoming dehydrated. As such, I have two quesions.

1. Is there any safe level of PSE use during exercise when indicated - eg to clear congestion - or should it be absolutely avoided?

2. If it is sufficiently safe for occasional use is there a sensible protocol for PSE ingestion in combination with caffeine prior to exercise to gain an ergogenic benefit?

I would defintiely avoid its use as a performance enhancer. It definitely jacks your heart rate up. You do run the risk of blowing up, just from a racing point of view, but I think cardiac arrhythmias etc are the real risk. Whn I was a medical intern, a fellow intern took the recommended dose of 60 mg at too close an interval--he was a bit sick with a cold and also wanted help staying up--he spent the night on call in the ER hooked up to an EKG. I had to cover his patients...he was so embarassed he never let us tease him about it.

I remember taking it for sinus problems after a flight to Australia-so I might have been a bit sick, but I went with some guys who regularly rode in Melbourne with Cadel Evans and that crew and we were flying along a beach road. I was flying along staying with these guys at 30mph up and down these undulating roads--a bit surprised in fact that I was-I started feeling a bit weird...and then blew sky high. Felt dizzy, like my heart was in my throat. Then realized I was absolutely pruple in the face from heat, got off my bike, and ran into the ocean and jsut sat there for several minutes. The rest of the group never even saw me leave. Took my two days to feel better.

I do think it is performance enhacing but quite variable.

Roadie_scum said:

If you don't know... check!

Section 6 of the WADA prohibited substances list states that each of ephedrine and methylephedrine is prohibited when concentrations reach 10 micrograms/liter in urine. It also states that pseudoephedrine is not a prohibited substance but is on the monitoring list.

You can find the list at: http://www.wada-ama.org/en/dynamic.ch2?pageCategory_id=47

Why do they ban one and not the other? I was told by my Doctor that pseudo was a synthetic equal to ephedrine and virtually identical in effect....
is my doctor wrong is WADA wierd?

You start off by saying that you don't understand why a cyclist would add caffeine or stimulants for cycling and then say it's just a personal thing?

I've talked to MANY cyclists who use thermogenics or straight caffeine or those energy supplements with things like caffeine, tyrosine, B12 and the like. For a lot of people it's a mental thing where they can push themselves harder because they don't perceive the physical fatigue as much as they may normally. I've used these supplements in the past, but not for riding. I'd personally only use caffeine, or something without synephrine or ephedrine or that evodia stuff, as it'll just rev up my heart rate and make me sweat more than I already do.

Felt_Rider said:

Not being a competitive cyclist, but being fairly knowledgeable in sports supplements and various PED's I do not understand why cyclist would add in stimulants now for the very reason that Fixey just stated.

I didn't understand this at first, but lately I have noticed my worst rides are when I have too much caffiene or other stimulants like the bitter orange.

On those days my heart rate is high even during a light warmup and when I begin to push for intervals I cannot push hard because my heart rate sky rockets immediately and then I cannot recover unless I pull to the side and rest until it comes back under control. Bad enough that a slow pace my heart rate will not calm down unless I pull to the side.

I count this as something perhaps individual to me, but it seems like this would have at least some impact even to those who do not have a heart rate problem. The guy that I ride with does not seem to be affected by the caffiene he drinks before a ride.

I have learned that stimulants are a bad thing for me personally as far as cycling or interval training.

According to WADA ephedrine is banned if its concentration in urine is greater than 10 micrograms per millilitre.

But pseudoephedrine is monitored but not banned:

The substances included in the 2005 Monitoring Program (bupropion, caffeine, phenylephrine, phenylpropanolamine, pipradrol, pseudoephedrine, synephrine) are not considered as Prohibited Substances

So WADA considers ephedrine and pseudoephedrine not to be a pigeon pair.

probably because pseudoephedrine is a very common ingredient in OTC nasal decongestants! :p

VeloFlash said:

According to WADA ephedrine is banned if its concentration in urine is greater than 10 micrograms per millilitre.

But pseudoephedrine is monitored but not banned:

The substances included in the 2005 Monitoring Program (bupropion, caffeine, phenylephrine, phenylpropanolamine, pipradrol, pseudoephedrine, synephrine) are not considered as Prohibited Substances

So WADA considers ephedrine and pseudoephedrine not to be a pigeon pair.

prostiak said:

probably because pseudoephedrine is a very common ingredient in OTC nasal decongestants! :p

And possibly because it has been reported to have no performance enhancing qualities, except in combination with caffeine, where the data is muddy.

And possibly because it has been linked to fewer deaths than ephedrine. Although a higher prevalence of sinus arrythmias I think has been reported which is a little worrying.

So anyone with actual knowledge want to step us through this and answer the original questions?

Is PSE safe as a performance enhancer in combination with caffeine?
Is PSE effective as a performance enhancer in combination with caffeine?
Is PSE safe as a nasal decongestant during exercise?
What protocols and dosages should be followed when taking PSE for either of the purposes outlined above?

And a supplementary question raised to the ones above: is PSE different pharmacologically to ephedrine and if so how?

hombredesubaru said:

I would defintiely avoid its use as a performance enhancer. It definitely jacks your heart rate up. You do run the risk of blowing up, just from a racing point of view, but I think cardiac arrhythmias etc are the real risk. Whn I was a medical intern, a fellow intern took the recommended dose of 60 mg at too close an interval--he was a bit sick with a cold and also wanted help staying up--he spent the night on call in the ER hooked up to an EKG. I had to cover his patients...he was so embarassed he never let us tease him about it.

OK. You scared me!

Quoted post said:

but I went with some guys who regularly rode in Melbourne with Cadel Evans and that crew and we were flying along a beach road.

Russ, Pete 1, Pete 2 or one of the other boys from spoke'n? The IM tri connection from cafe racer to portsea return? T Lowe, J Maebus and the MTB posse?

prostiak said:

You start off by saying that you don't understand why a cyclist would add caffeine or stimulants for cycling and then say it's just a personal thing?

I've talked to MANY cyclists who use thermogenics or straight caffeine or those energy supplements with things like caffeine, tyrosine, B12 and the like. For a lot of people it's a mental thing where they can push themselves harder because they don't perceive the physical fatigue as much as they may normally. I've used these supplements in the past, but not for riding. I'd personally only use caffeine, or something without synephrine or ephedrine or that evodia stuff, as it'll just rev up my heart rate and make me sweat more than I already do.

Then you sound like you react to the thermogenic stack much in the same way that I do.

I probably could get away with just straight caffiene because it seems that the results are more predictable. It is the combination that seems to be unpredictable so to clarify my seemingly contradictory statement I just feel like the combination is too risky to try before a race.

Perhaps not risky for health hazards (taken as prescribed or lower than prescribed doses) as much as it may make your heart rate rev too high at unexpected times during a push. It is the unpredictable nature of the combination and the risk to the race results that I was considering.

I have been around this for a long time and can say with confidence that generally speaking the stack is unpredictable for most people. I have been using thermogenics daily for over 10 years. The majority of the time I have not experienced any adverse effects, but on a few occasions I have had some close calls and lately when applied to cycling or endurance events I find the stack to have adverse effects for me and have blown up and have to pull off to the side to let my heart rate calm down. Now on cycling days I am taking a very low dose of synepherine and caffiene. The synepherine to help open my sinus to I can breathe freely and the caffiene of course is just to wake me up.

Hey, I am all for people experimenting, but I am also not going to hide the dangers if I happen to know those dangers.

I think Hombred's comments are along the same line of concern.

Fixey said:

No it isnt...... at least im 95% sure it isnt anymore.

You're right- ephedrine is still available- at least via mail order in the U.S.-
Look here: (D&E Pharmaceuticals) 🙄
dnepharm.comprivacypolicy.htmOpen ↗
In fact, I just got finished with a *live chat* with a
customer service representative, and she said that
i could order it- if i send a copy of two forms of I.D.
to prove that you are over age 18 (which can be done via fax, as well).

Their prices are *very* reasonable, compared to other
sources. 🙂
Also available here:
nutribolicinc.com361Open ↗
Hope this helps- for those interested.