Drug interactions
Cocaine + Pseudoephedrine
Severity: Major
Cocaine and Pseudoephedrine: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Both drugs have sympathomimetic activity. Topical cocaine used in nasal procedures is absorbed systemically and may add to pseudoephedrine to cause hypertension, tachycardia and arrhythmias.
What this interaction means in plain words
Cocaine and Pseudoephedrine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Cocaine belongs to Central Nervous System; Pseudoephedrine belongs to Respiratory.
Why it happens
Additive sympathomimetic effects; cocaine blocks catecholamine reuptake while pseudoephedrine releases norepinephrine.
What to do
Avoid pseudoephedrine around topical cocaine use and monitor blood pressure and ECG if this cannot be avoided.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Pseudoephedrine
- Isocarboxazid + Pseudoephedrine Contraindicated
- Phenelzine + Pseudoephedrine Contraindicated
- Pseudoephedrine + Rasagiline Contraindicated
- Pseudoephedrine + Selegiline Contraindicated
- Pseudoephedrine + Selegiline transdermal Contraindicated
- Pseudoephedrine + Tranylcypromine Contraindicated
Other interactions of Cocaine
- Cocaine + Isocarboxazid Contraindicated
- Cocaine + Phenelzine Contraindicated
- Cocaine + Procarbazine Contraindicated
- Amitriptyline + Cocaine Major
- Bisoprolol + Cocaine Major
- Citalopram + Cocaine Major
Frequently asked questions
Can I take Cocaine with Pseudoephedrine?
MediHelp rates the interaction as major. Cocaine and Pseudoephedrine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Both drugs have sympathomimetic activity. Topical cocaine used in nasal procedures is absorbed systemically and may add to pseudoephedrine to cause hypertension, tachycardia and arrhythmias.
How serious is the interaction between Cocaine and Pseudoephedrine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid pseudoephedrine around topical cocaine use and monitor blood pressure and ECG if this cannot be avoided.
What other medicines interact with Pseudoephedrine?
MediHelp also lists interactions of Pseudoephedrine with, for example, Isocarboxazid, Phenelzine, Rasagiline. The full list is on the Pseudoephedrine page.
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