Pseudoephedrine

Nasal congestion Pseudoephedrine is a sympathomimetic and is well known for shrinking swollen nasal mucous membranes, so it is often used as a decongestant. It reduces tissue hyperemia, edema, and nasal congestion commonly associated with colds or allergies. Other beneficial effects may include increasing the drainage of sinus secretions, and opening of obstructed Eustachian tubes. The same vasoconstriction action can also result in hypertension, which is a noted side effect of pseudoephedrine. Pseudoephedrine can be used either as oral or as topical decongestant. Due to its stimulating qualities, however, the oral preparation is more likely to cause adverse effects, including urinary retention. According to one study, pseudoephedrine may show effectiveness as an antitussive drug (suppression of cough). Pseudoephedrine is indicated for the treatment of nasal congestion, sinus congestion, and Eustachian tube congestion. Pseudoephedrine is also indicated for vasomotor rhinitis and as an adjunct to other agents in the optimum treatment of allergic rhinitis, croup, sinusitis, otitis media, and tracheobronchitis. Pseudoephedrine at therapeutic doses does not appear to improve or worsen daytime sleepiness, daytime fatigue, or sleep quality in people with allergic rhinitis. Likewise, somnolence was not lower in children with the common cold treated with pseudoephedrine for nasal congestion. In any case, insomnia is a known side effect of pseudoephedrine, although the incidence is low. However, due to lack of clinical data and potential cardiovascular side effects, this use is not recommended. This was in contrast to phenylpropanolamine, which has been found to be more effective at promoting weight loss compared to placebo and has been more widely studied and used in the treatment of obesity. and postural orthostatic tachycardia syndrome (POTS). However, its effectiveness in the treatment of POTS is controversial. However, data on this use are limited to case reports and case series. Erection is largely a parasympathetic response, so the sympathetic action of pseudoephedrine may serve to relieve this condition. Data for this use are however anecdotal and effectiveness has been described as variable. Available forms Pseudoephedrine is available by itself over-the-counter in the form of 30 and 60mg immediate-release and 120 and 240mg extended-release oral tablets in the United States. Pseudoephedrine is also available over-the-counter and prescription-only in combination with numerous other drugs, including antihistamines (acrivastine, azatadine, brompheniramine, cetirizine, chlorpheniramine, clemastine, desloratadine, dexbrompheniramine, diphenhydramine, fexofenadine, loratadine, triprolidine), analgesics (acetaminophen, codeine, hydrocodone, ibuprofen, naproxen), cough suppressants (dextromethorphan), and expectorants (guaifenesin). Pseudoephedrine has been used in the form of the hydrochloride and sulfate salts and in a polistirex form. The drug has been used in more than 135 over-the-counter and prescription formulations. Many prescription formulations containing pseudoephedrine have been discontinued over time. ==Contraindications==

Pseudoephedrine is contraindicated in patients with diabetes mellitus, cardiovascular disease, severe or uncontrolled hypertension, severe coronary artery disease, prostatic hypertrophy, hyperthyroidism, closed-angle glaucoma, or by pregnant women. ==Side effects==

Common side effects with pseudoephedrine therapy may include central nervous system (CNS) stimulation, insomnia, restlessness, excitability, dizziness, and anxiety. Pseudoephedrine, particularly when combined with other drugs including narcotics, may also play a role in the precipitation of episodes of psychosis. It has also been reported that pseudoephedrine, among other sympathomimetic agents, may be associated with the occurrence of hemorrhagic stroke and other cardiovascular complications. Systolic blood pressure was found to slightly increase by 0.99mmHg on average and heart rate was found to slightly increase by 2.83bpm on average. The withdrawal symptoms included worsened mood and sadness, profoundly decreased energy, a worsened view of oneself, decreased concentration, psychomotor retardation, increased appetite, and increased need for sleep. However, it is substantially less potent than methamphetamine or cocaine. ==Overdose==

The maximum total daily dose of pseudoephedrine is 240mg. Symptoms of overdose may include sedation, apnea, impaired concentration, cyanosis, coma, circulatory collapse, insomnia, hallucinations, tremors, convulsions, headache, dizziness, anxiety, euphoria, tinnitus, blurred vision, ataxia, chest pain, tachycardia, palpitations, increased blood pressure, decreased blood pressure, thirstiness, sweating, difficulty with urination, nausea, and vomiting. In children, symptoms have more often included dry mouth, pupil dilation, hot flashes, fever, and gastrointestinal dysfunction. Pseudoephedrine may produce toxic effects both with use of supratherapeutic doses but also in people who are more sensitive to the effects of sympathomimetics. Misuse of the drug has been reported in one case at massive doses of 3,000 to 4,500mg (100–150×30-mg tablets) per day, with the doses gradually increased over time by this individual. No fatalities due to pseudoephedrine misuse have been reported as of 2021. However, death with pseudoephedrine has been reported generally. ==Interactions==

Concomitant or recent (previous 14days) monoamine oxidase inhibitor (MAOI) use can lead to hypertensive reactions, including hypertensive crisis, and should be avoided. This is in accordance with the fact that pseudoephedrine is not metabolized by monoamine oxidase (MAO). Increase of ectopic pacemaker activity can occur when pseudoephedrine is used concomitantly with digitalis. Urinary acidifying agents like ascorbic acid and ammonium chloride can increase the excretion of and thereby reduce exposure to amphetamines including pseudoephedrine, whereas urinary alkalinizing agents including antacids like sodium bicarbonate as well as acetazolamide can reduce the excretion of these agents and thereby increase exposure to them. ==Pharmacology==

Pharmacodynamics Pseudoephedrine is a sympathomimetic agent which acts primarily or exclusively by inducing the release of norepinephrine. Pseudoephedrine induces monoamine release in vitro with an of 224nM for norepinephrine and 1,988nM for dopamine, whereas it is inactive for serotonin. As such, it is about 9-fold selective for induction of norepinephrine release over dopamine release. It was an antagonist or very weak partial agonist of the β3-adrenergic receptor (Kact = ; = 7%). The vasoconstriction that pseudoephedrine produces is believed to be principally an α-adrenergic receptor response. Pseudoephedrine acts on α- and β2-adrenergic receptors, to cause vasoconstriction and relaxation of smooth muscle in the bronchi, respectively. Clinical studies have found that pseudoephedrine is about 3.5- to 4-fold less potent than ephedrine as a sympathomimetic agent in terms of blood pressure increases and 3.5- to 7.2-fold less potent as a bronchodilator. Blood vessels in the nose are around five times more sensitive than the heart to the actions of circulating epinephrine (adrenaline), which may help to explain how pseudoephedrine at the low doses used in over-the-counter products can produce nasal decongestion with minimal effects on the heart. It is far less potent in this action than other agents like dextroamphetamine and moclobemide. As such, they have a greater ratio of peripheral cardiovascular to central psychostimulant effect. ==Chemistry==

Pseudoephedrine, also known structurally as (1S,2S)-α,N-dimethyl-β-hydroxyphenethylamine or as (1S,2S)-N-methyl-β-hydroxyamphetamine, is a substituted phenethylamine, amphetamine, and β-hydroxyamphetamine derivative. It has an experimental log P of 0.89, while its predicted log P values range from 0.9 to 1.32. The compound is relatively lipophilic, but is also more hydrophilic than other amphetamines. For comparison to pseudoephedrine, the experimental log P of methamphetamine is 2.1, of amphetamine is 1.8, of phenylpropanolamine is 0.7, of phenylephrine is -0.3, and of norepinephrine is -1.2. Methamphetamine has high brain permeability, The optimal log P for brain permeation and central activity is about 2.1 (range 1.5–2.7). Pseudoephedrine is readily reduced into methamphetamine or oxidized into methcathinone. Often the system (with small caps) and the d/l system (with lower-case) are confused. The result is that the dextrorotary d-pseudoephedrine is wrongly named pseudoephedrine and the levorotary l-ephedrine (the diastereomer) wrongly ephedrine. The IUPAC names of the two enantiomers are (1S,2S)- respectively (1R,2R)-2-methylamino-1-phenylpropan-1-ol. Synonyms for both are psi-ephedrine and threo-ephedrine. Pseudoephedrine is the of the (+)-form, when used as pharmaceutical substance. Detection in body fluids Pseudoephedrine may be quantified in blood, plasma, or urine to monitor any possible performance-enhancing use by athletes, confirm a diagnosis of poisoning, or to assist in a medicolegal death investigation. Some commercial immunoassay screening tests directed at the amphetamines cross-react appreciably with pseudoephedrine, but chromatographic techniques can easily distinguish pseudoephedrine from other phenethylamine derivatives. Blood or plasma pseudoephedrine concentrations are typically in the 50 to 300μg/L range in persons taking the drug therapeutically, 500 to 3,000μg/L in people with substance use disorder involving pseudoephedrine or poisoned patients, and 10 to 70mg/L in cases of acute fatal overdose. ==Manufacturing==

Although pseudoephedrine occurs naturally as an alkaloid in certain plant species (for example, as a constituent of extracts from the Ephedra species, also known as ma huang, in which it occurs together with other isomers of ephedrine), the majority of pseudoephedrine produced for commercial use is derived from yeast fermentation of dextrose in the presence of benzaldehyde. In this process, specialized strains of yeast (typically a variety of Candida utilis or Saccharomyces cerevisiae) are added to large vats containing water, dextrose and the enzyme pyruvate decarboxylase (such as found in beets and other plants). After the yeast has begun fermenting the dextrose, the benzaldehyde is added to the vats, and in this environment, the yeast converts the ingredients to the precursor l-phenylacetylcarbinol (L-PAC). L-PAC is then chemically converted to pseudoephedrine via reductive amination. The bulk of pseudoephedrine is produced by commercial pharmaceutical manufacturers in India and China, where economic and industrial conditions favor its mass production for export. ==History==

Pseudoephedrine, along with ephedrine, occurs naturally in ephedra. This herb has been used for thousands of years in traditional Chinese medicine. It was first synthesized in the 1920s in Japan. Subsequently, pseudoephedrine was introduced for medical use as a decongestant. ==Society and culture==

Generic names Pseudoephedrine is the generic name of the drug and its and , while pseudoéphédrine is its and pseudoefedrina is its . Pseudoephedrine hydrochloride is its and in the case of the hydrochloride salt; pseudoephedrine sulfate is its in the case of the sulfate salt; pseudoephedrine polistirex its in the case of the polistirex form; and d-isoephedrine sulfate is its in the case of the sulfate salt. • Cirrus (made by UCB) — contains 120 mg pseudoephedrine hydrochloride (also 5 mg cetirizine). • Claritin-D (made by Bayer Healthcare) — contains 120 mg of pseudoephedrine sulfate (also 5 mg of loratadine). • Claritin-D 24 Hour (made by Bayer Healthcare) — contains 240 mg of pseudoephedrine sulfate (also 10 mg of loratadine). • Codral (made by Asia-Pacific subsidiary of Johnson & Johnson) — Codral Original contains pseudoephedrine, Codral New Formula substitutes phenylephrine for pseudoephedrine. • Congestal (made by SIGMA Pharmaceutical Industries) — contains 60 mg pseudoephedrine hydrochloride (also 650 mg paracetamol and 4 mg chlorpheniramine). • Contac (made by GlaxoSmithKline) — previously contained pseudoephedrine, now contains phenylephrine. As at Nov 2014 UK version still contains 30 mg pseudoephedrine hydrochloride per tablet. • Demazin (made by Bayer Healthcare) — contains pseudoephedrine sulfate and chlorpheniramine maleate • Eltor (made by Sanofi Aventis) — contains pseudoephedrine hydrochloride. • Mucinex-D (made by Reckitt Benckiser) — contains 60 mg pseudoephedrine hydrochloride (also 1200 mg guaifenesin). • Nexafed (made by Acura Pharmaceuticals) — contains 30 mg pseudoephedrine per tablet, formulated with Impede Meth-Deterrent technology. • Nurofen Cold & Flu (made by Reckitt Benckiser) — contains 30 mg pseudoephedrine hydrochloride (also 200 mg ibuprofen). • Respidina – contains 120 mg of pseudoephedrine in the form of extended release tablets. • Rhinex Flash (made by Pharma Product Manufacturing, Cambodia) — contains pseudoephedrine combined with paracetamol and triprolidine. • Rhinos SR (made by Dexa Medica) — contains 120 mg of pseudoephedrine hydrochloride • Sinutab (made by McNeil Consumer Healthcare, a Kenvue Company) — contains 500 mg paracetamol and 30 mg pseudoephedrine hydrochloride. • Sudafed Decongestant (made by McNeil Consumer Healthcare) — contains 60 mg of pseudoephedrine hydrochloride. Not to be confused with Sudafed PE, which contains phenylephrine. • Theraflu (made by Novartis) — previously contained pseudoephedrine, now contains phenylephrine • Trima — contains 60 mg pseudoephedrine hydrochloride • Tylol Hot (made by NOBEL İLAÇ SANAYİİ VE TİCARET A.Ş., Turkey) — a packet of 20 g contains 60 mg pseudoephedrine hydrochloride, 500 mg paracetamol and 4 mg chlorpheniramine maleate • Unifed (made by United Pharmaceutical Manufacturer, Jordan) — contains pseudoephedrine hydrochloride (also triprolidine and guaifenesin). • Zyrtec-D 12 Hour (made by McNeil Consumer Healthcare, a Kenvue company) — contains 120 mg pseudoephedrine hydrochloride (also 5 mg of cetirizine). • Zephrex-D (made by Westport Pharmaceuticals) – a special meth-resistant form of pseudoephedrine that becomes gooey when heated. Recreational use Over-the-counter pseudoephedrine has been misused as a psychostimulant. Six case reports and one case series of pseudoephedrine misuse have been published as of 2021. Use in exercise and sports Pseudoephedrine has been used as a performance-enhancing drug in exercise and sports due to its sympathomimetic and stimulant effects. Because of these effects, pseudoephedrine can increase heart rate, elevate blood pressure, improve mental energy, and reduce fatigue, among other performance-enhancing effects. Pseudoephedrine is excreted through urine, and the concentration in urine of this drug shows a large inter-individual spread; that is, the same dose can give a vast difference in urine concentration for different individuals. Pseudoephedrine is approved to be taken up to 240 mg per day. In seven healthy male subjects, this dose yielded a urine concentration range of 62.8 to 294.4 microgram per milliliter (μg/mL) with mean ± standard deviation 149 ± 72 μg/mL. Thus, normal dosage of 240 mg pseudoephedrine per day can result in urine concentration levels exceeding the limit of 150 μg/mL set by WADA for about half of all users. Furthermore, hydration status does not affect the urinary concentration of pseudoephedrine. List of doping cases • Canadian rower Silken Laumann was stripped of her 1995 Pan American Games team gold medal after testing positive for pseudoephedrine. • In February 2000, Elena Berezhnaya and Anton Sikharulidze won gold at the 2000 European Figure Skating Championships but were stripped of their medals after Berezhnaya tested positive. This resulted in a three-month disqualification from the date of the test, and the medal being stripped. She stated that she had taken cold medication approved by a doctor but had failed to inform the ISU as required. The pair missed the World Championships that year as a result of the disqualification. • Romanian gymnast Andreea Răducan was stripped of her gold medal at the 2000 Summer Olympic Games after testing positive. She took two pills given to her by the team coach for a cold. Although she was stripped of the overall gold medal, she kept her other medals, and, unlike in most other doping cases, was not banned from competing again; only the team doctor was banned for a number of years. Ion Țiriac, the president of the Romanian Olympic Committee, resigned over the scandal. • In the 2010 Winter Olympic Games, the IOC issued a reprimand against the Slovak ice hockey player Lubomir Visnovsky for usage of pseudoephedrine. • In the 2014 Winter Olympic Games Team Sweden and Washington Capitals ice hockey player Nicklas Bäckström was prevented from playing in the final for usage of pseudoephedrine. Bäckström claimed he was using it as allergy medication. In March 2014, the IOC Disciplinary Commission decided that Bäckström would be awarded the silver medal. In January 2015 Bäckström, the IOC, WADA and the IIHF agreed to a settlement in which he accepted a reprimand but was cleared of attempting to enhance his performance. Manufacture of amphetamines Its membership in the amphetamine class has made pseudoephedrine a sought-after chemical precursor in the illicit manufacture of methamphetamine and methcathinone. In the United States, federal laws control the sale of pseudoephedrine-containing products. Their policies restrict sales by limiting purchase quantities and requiring a minimum age and government issued photographic identification. Legal status Australia Illicit diversion of pseudoephedrine in Australia has caused significant changes to the way the products are regulated. , all products containing pseudoephedrine have been rescheduled as either "Pharmacist Only Medicines" (Schedule 3) or "Prescription Only Medicines" (Schedule 4), depending on the amount of pseudoephedrine in the product. A Pharmacist Only Medicine may only be sold to the public if a pharmacist is directly involved in the transaction. These medicines must be kept behind the counter, away from public access. Pharmacists are also encouraged (and in some states required) to log purchases with the online database Project STOP. As a result, some pharmacies no longer stock Sudafed, the common brand of pseudoephedrine cold/sinus tablets, opting instead to sell Sudafed PE, a phenylephrine product that has not been proven effective in clinical trials. However, new legislation came into effect in November 2024, banning the over-the-counter sale of all medicines containing pseudoephedrine. Canada Health Canada has investigated the risks and benefits of pseudoephedrine and ephedrine/Ephedra. Near the end of the study, Health Canada issued a warning on their website stating that those who are under the age of 12, or who have heart disease and may have strokes, should avoid taking pseudoephedrine and ephedrine. Also, they warned that everyone should avoid taking ephedrine or pseudoephedrine with other stimulants like caffeine. They also banned all products that contain both ephedrine (or pseudoephedrine) and caffeine. Products whose only medicinal ingredient is pseudoephedrine must be kept behind the pharmacy counter. Products containing pseudoephedrine along with other medicinal ingredients may be displayed on store shelves but may be sold only in a pharmacy when a pharmacist is present. Colombia The Colombian government prohibited the trade of pseudoephedrine in 2010. Estonia Pseudoephedrine is an over-the-counter drug in Estonia. Finland Pseudoephedrine medicines can only be obtained with a prescription in Finland. France Pseudoephedrine-containing combination products were available over-the-counter from pharmacies, most commonly with paracetamol, under the brand names "Dolirhume","Actifed Rhyme Jour et Nuit" et al. Products combining pseudoephedrine and ibuprofen or certain antihistamines were also available (e.g. "Rhinadvil"). However, products containing pseudoephedrine as a single ingredient are not sold. In October 2023, the French health department officially warned against the usage of pseudoephedrine for patients with a cold. It also suggested the substance's availability could be restricted in the future, pending its pharmaceutical re-evaluation on EU level. In December 2024, the government announced pseudoephedrine medicines would henceforth only be obtainable with a prescription. Germany Various pseudoephedrine-containing products in combination with ibuprofen, aspirin, or antihistamines can be obtained without a prescription upon request at a pharmacy. Common names include Aspirin Complex, Reactine Duo, and RhinoPront. Products containing pseudoephedrine as a single ingredient are not available. Japan Medications that contain more than 10% pseudoephedrine are prohibited under the Stimulants Control Law in Japan. Mexico On 23 November 2007, the use and trade of pseudoephedrine in Mexico was made illegal as it was argued that it was extremely popular as a precursor in the synthesis of methamphetamine. Netherlands Pseudoephedrine was withdrawn from sale in 1989 due to concerns about adverse cardiac side effects. New Zealand Since April 2024, pseudoephedrine has been classified as a restricted (pharmacist-only) drug in the Misuse of Drugs Act 1975 which allows the purchase of medicines containing pseudoephedrine from a pharmacist without a prescription. Pseudoephedrine, ephedrine, and any product containing these substances, e.g. cold and flu medicines, were first classified in October 2004 as Class C Part III (partially exempted) controlled drugs, due to being the principal ingredient in methamphetamine. New Zealand Customs and police officers continued to make large interceptions of precursor substances believed to be destined for methamphetamine production. On 9 October 2009, Prime Minister John Key announced pseudoephedrine-based cold and flu tablets would become prescription-only drugs and reclassified as a class B2 drug. The law was amended by The Misuse of Drugs Amendment Bill 2010, which passed in August 2011. In November 2023, the National-led coalition government announced that the sale of cold medication containing pseudoephedrine would be allowed (as part of the coalition agreement between the National and ACT parties). Switzerland Pseudoephedrine is available without a prescription in combination (with aspirin) under the brand name "Aspirin Complex." There is also a preparation consisting of a single ingredient 120 mg extended-release tablet that can be obtained at pharmacies with a prescription or after consultation with a pharmacist. Turkey In Turkey, medications containing pseudoephedrine are available by prescription only. United Kingdom In the UK, pseudoephedrine is available over-the-counter under the supervision of a qualified pharmacist, or on prescription. In 2007, the MHRA reacted to concerns over the diversion of ephedrine and pseudoephedrine for the illicit manufacture of methamphetamine by introducing voluntary restrictions limiting over-the-counter sales to one box containing no more than 720 mg of pseudoephedrine in total per transaction. These restrictions became law in April 2008. No form of ID is required. United States Federal The United States Congress has recognized that pseudoephedrine is used in the illegal manufacture of methamphetamine. In 2005, the Committee on Education and the Workforce heard testimony concerning education programs and state legislation designed to curb this illegal practice. Attempts to control the sale of the drug date back to 1986, when federal officials at the Drug Enforcement Administration (DEA) first drafted legislation, later proposed by Senator Bob Dole, that would have placed several chemicals used in the manufacture of illicit drugs under the Controlled Substances Act. The bill would have required each transaction involving pseudoephedrine to be reported to the government, and federal approval of all imports and exports. Fearing this would limit legitimate use of the drug, lobbyists from over-the-counter drug manufacturing associations sought to stop this legislation from moving forward and were successful in exempting from the regulations all chemicals that had been turned into a legal final product, such as Sudafed. Before the passage of the Combat Methamphetamine Epidemic Act of 2005, sales of the drug became increasingly regulated, as DEA regulators and pharmaceutical companies continued to fight for their respective positions. The DEA continued to make greater progress in its attempts to control pseudoephedrine as methamphetamine production skyrocketed, becoming a serious problem in the western United States. When purity dropped, so did the number of people in rehab and people admitted to emergency rooms with methamphetamine in their systems. This reduction in purity was usually short-lived, however, as methamphetamine producers eventually found a way around the new regulations. Congress passed the Combat Methamphetamine Epidemic Act of 2005 (CMEA) as an amendment to the renewal of the USA Patriot Act. Signed into law by President George W. Bush on 6 March 2006, Though the law was mainly directed at pseudoephedrine products it also applies to all over-the-counter products containing ephedrine, pseudoephedrine, and phenylpropanolamine, their salts, optical isomers, and salts of optical isomers. • Presents a government-issued photographic identification; and • Signs the written logbook with name, address, and time and date of the sale State Most states also have laws regulating pseudoephedrine. The states of Alabama, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Hawaii () Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana (), Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia and Wisconsin have laws requiring pharmacies to sell pseudoephedrine "behind the counter." Though the drug can be purchased without a prescription, states can limit the number of units sold and can collect personal information from purchasers. The states of Oregon and Mississippi previously required a prescription for the purchase of products containing pseudoephedrine. However, as of 1 January 2022, these restrictions have been repealed. The state of Oregon reduced the number of methamphetamine lab seizures from 448 in 2004 (the final full year before implementation of the prescription only law) to a new low of 13 in 2009. The decrease in meth lab incidents in Oregon occurred largely before the prescription-only law took effect, according to a NAMSDL report titled Pseudoephedrine Prescription Laws in Oregon and Mississippi. Union, New Haven, Cape Girardeau and Ozark. Certain pharmacies in Terre Haute, Indiana do so as well. Another approach to controlling the drug on the state level mandated by some state governments to control the purchases of their citizens is the use of electronic tracking systems, which require the electronic submission of specified purchaser information by all retailers who sell pseudoephedrine. Thirty-two states now require the National Precursor Log Exchange (NPLEx) to be used for every pseudoephedrine and ephedrine OTC purchase, and ten of the eleven largest pharmacy chains in the US voluntarily contribute all of their similar transactions to NPLEx. These states have seen dramatic results in reducing the number of methamphetamine laboratory seizures. Before the implementation of the system in Tennessee in 2005, methamphetamine laboratory seizures totaled 1,497 in 2004 but were reduced to 955 in 2005, and 589 in 2009. ==Research==

Pseudoephedrine has been studied in the treatment of snoring. However, data are inadequate to support this use. This might have been due to suppression of prolactin secretion. Pseudoephedrine might be useful for lactation suppression. ==References==