Up-to-Date Information on Ephedrine and Pseudoephedrine

Ephedrine and pseudoephedrine are two drugs that occur naturally in the plant species Ephedra sinica, known in traditional Chinese medicine as ma huang. Both of these substances are common ingredients in a variety of prescription and nonprescription medications used to treat colds, hay fever, and allergies. Not coincidentally, they bear a strong chemical resemblance to the legal stimulant drug amphetamine and the illegal stimulant drug methamphetamine. In fact, illicit drug manufacturers commonly use either ephedrine or pseudoephedrine to produce methamphetamine. For this reason, federal laws in the United States strongly restrict these substances’ legal usage.

The Basics

Both ephedrine and pseudoephedrine belong to a class of substances called sympathomimetic amines, which get their name because they increase the normal rate of activity in the sympathetic nervous system. This involuntary nerve network plays its most prominent role by activating the “fight-or-flight” reflex in response to stressful, threatening, or dangerous situations; however, it also helps maintain a stable internal environment that supports normal body function and ongoing good health. Inside the body, ephedrine and pseudoephedrine trigger changes in the sympathetic nervous system that produce effects such as nasal decongestion, sinus decongestion and an increased level of stimulation associated with alertness and heightened concentration. Ephedrine, in particular, also triggers a significant reduction in normal appetite levels.

In chemical terms, ephedrine is so closely related to amphetamine that scientists sometimes refer to it as a “substituted amphetamine.” In addition, it takes only minor alterations to ephedrine’s molecules to produce methamphetamine. In turn, pseudoephedrine is so closely related to ephedrine that it differs only in minor details of its chemical structure. As stated previously, both ephedrine and pseudoephedrine occur naturally in the ma huang plant (as well as in other related Ephedra species). However, the forms of these substances used in medications typically come from synthetic processes undertaken in a controlled laboratory setting.

Until 2004, ephedrine was the main ingredient in a variety of dietary supplements marketed for weight control, energy boosting or the enhancement of athletic performances. However, as a result of concerns over the safety of these products, the US Food and Drug Administration banned ephedrine’s use in all products sold as dietary supplements. As of 2013, current federal guidelines allow manufacturers of prescription and nonprescription medications to include the drug in their products. Compared to supplement manufacturers, medication manufacturers undergo much more stringent forms of ongoing monitoring and oversight. Pseudoephedrine is also the main ingredient in a variety of prescription and nonprescription medications. Products that contain ephedrine include Primatene Asthma, Rentamine, and Asthmacon. Products that contain pseudoephedrine include Sudafed, Afrinol, Lortuss DM, and Advil Cold and Sinus.

Potential Risks

Most serious risks of ephedrine use occur in people who take oral or injected preparations of the drug, not nasal preparations. Potential complications include nausea, sweating, skin flushing, an unusually rapid heartbeat, an irregular heartbeat, a narrowing of the blood vessels that produces high blood pressure, a form of heart-related chest pain called angina, insomnia, mental confusion, paranoia, agitation, shortness of breath and abnormal accumulation of fluid in the lungs. Most of these symptoms are also potential side effects of pseudoephedrine use; in addition, some evidence suggests that pseudoephedrine use may produce an increase in a person’s overall stroke risks. Not surprisingly, many of the potential side effects of ephedrine and pseudoephedrine use closely resemble some of the effects of both amphetamine and methamphetamine use. However, amphetamine and methamphetamine produce much stronger (and therefore more dangerous) forms of these effects.

Links to Illegal Drug Production

As stated previously, both ephedrine and pseudoephedrine frequently play key roles in the illegal manufacture of methamphetamine. This use extends back to the 1980s, when underground chemists mistakenly stumbled upon the drugs while looking for a new way to illegally produce amphetamine. In addition, some illegal drug manufacturers use ephedrine or pseudoephedrine to make another illegal stimulant drug called methcathinone, which bears a close resemblance to methamphetamine.

Because of their potential role in methamphetamine and methcathinone production, drug control authorities refer to ephedrine and pseudoephedrine as precursor chemicals. In order to impede the activities of illegal drug producers, the U.S. government passed federal laws in 2005 that ban over-the-counter sales of both prescription and nonprescription products that contains these drugs. Federal law also limits the amount of ephedrine or pseudoephedrine anyone can buy at a given time, requires use of a photo ID during the purchase of these drugs, and also requires all retailers to keep records of ephedrine and pseudoephedrine purchases for a minimum of two calendar years. These same rules also apply to another decongesting stimulant drug called phenylpropanolamine.