Drug interactions
Ephedrine + Pseudoephedrine
Severity: Major
Ephedrine and Pseudoephedrine: major interaction.
Last updated Sources: UK SmPC
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
These two closely related sympathomimetics have overlapping effects, so combining them can cause excessive hypertension, tachycardia, palpitations, tremor and insomnia. The risk is greater in patients with cardiovascular disease.
What this interaction means in plain words
Ephedrine 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.
Ephedrine belongs to Cardiovascular; Pseudoephedrine belongs to Respiratory.
Why it happens
Duplicate indirect and mixed-acting sympathomimetic activity causing additive norepinephrine release and adrenergic receptor stimulation.
What to do
Avoid using both together and do not combine multiple decongestant products. If one is required for therapeutic reasons, monitor blood pressure and heart rate.
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
- Boots Decongestant Tablets - SmPC sections 4.3/4.5 (class statement: sympathomimetic decongestants; "Concomitant use of sympathomimetic decongestants, beta-blockers or monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping MAOI treatment (see sectio") — electronic medicines compendium (UK SmPC)
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 Ephedrine
- Ephedrine + Isocarboxazid Contraindicated
- Ephedrine + Phenelzine Contraindicated
- Ephedrine + Procarbazine Contraindicated
- Ephedrine + Rasagiline Contraindicated
- Ephedrine + Selegiline Contraindicated
- Ephedrine + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Ephedrine with Pseudoephedrine?
MediHelp rates the interaction as major. Ephedrine 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. These two closely related sympathomimetics have overlapping effects, so combining them can cause excessive hypertension, tachycardia, palpitations, tremor and insomnia. The risk is greater in patients with cardiovascular disease.
How serious is the interaction between Ephedrine 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 using both together and do not combine multiple decongestant products. If one is required for therapeutic reasons, monitor blood pressure and heart rate.
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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