Skip to main content
MyDeficiencies

Pseudoephedrine

oral sympathomimetic nasal decongestant

Also sold as Combination products.

Analyze another medication Medication directory

Findings for this medication

Research about this medication, graded for how strongly each finding can be attributed to it. Nothing here describes your own levels.

Pseudoephedrine has almost no classical depletion machinery. It is barely metabolized (about 1 to 6% N-demethylated to norpseudoephedrine), is excreted mostly unchanged in urine (43 to 96% across sources), and none of the labels opened mention any vitamin, mineral or other nutrient [1][2][4][7]. No CYP450 induction or inhibition is stated in the labels retrieved. The mechanisms that are present are not depletion mechanisms: a sympathomimetic effect that may shift potassium into cells and transiently raise glucose, a possible appetite effect on dietary intake, and urine pH, which changes how fast the drug itself is cleared. The red tier and the orange tier are both empty, and every graded entry is yellow.

oral sympathomimetic nasal decongestant · ATC R01BA02 (WHO ATC/DDD Index [3]) · also sold as Sudafed; many OTC generics and combination products · reviewed 2026-10-07. This describes research about the medication. It does not say anything about your own levels or health.

How to read the evidence grades

These colours describe how strongly a finding can be attributed to the medication in the research. They are not a severity score and they say nothing about your own health.

Grades describe how strongly a finding can be attributed to Pseudoephedrine in the research — not how common it is, how serious it would be, and not anything about you personally.

Red — Severe
Two or more independent Tier A sources, this drug in the cohort, the nutrient directly measured, consistent direction, clinically meaningful magnitude, a named mechanism, no substantial contradicting Tier A evidence.
Orange — Moderate
At least one Tier A source with this drug in the cohort showing a real but bounded deficit: an exposure window, a subgroup, low frequency, or a functional rather than circulating deficit.
Yellow — Low
Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction.
Not graded — disclosed evidence gap
Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result.Source definition: Not gradeable under the rules above because nothing has been measured. Published as a documented gap, never as reassurance that there is no effect.

What the research found

Potassium: compartmental shift after overdose and in cough-mixture abuse, case reports only

Yellow — Low

See study details

One adolescent with a serum potassium of 1.8 mmol/L after a pseudoephedrine and choline theophyllinate overdose showed a shift of potassium into cells with near-normal total balance, and one adult cough-mixture abuser had hypokalemia that the authors attributed to ephedrine and pseudoephedrine; there is no therapeutic-dose potassium data.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. Yellow

Limits on what this shows

  • Null findings: No study measuring serum potassium at labeled doses was located. The healthy-volunteer study that measured post-exercise glucose and insulin found no change [9], which weighs against a large insulin-mediated shift at the doses studied.
  • At-risk subgroups: Overdose; co-ingestion with other agents that lower serum potassium (the co-ingested choline theophyllinate prevents isolating pseudoephedrine in this case).

Regulatory status

No potassium statement on the Sudafed or cetirizine/pseudoephedrine OTC labels [1][2].

Population evidence

Case report [8] (Aust N Z J Med 1978; abstract read via OpenAlex, paraphrased by the fetch tool): a 17-year-old took an overdose of pseudoephedrine and choline theophyllinate; admission serum potassium 1.8 mmol/L, with tachycardia, tachypnoea and ankle clonus; hypokalaemia resolved and net potassium balance was only slightly positive (13 mmol). Sample size 1. Second case report, Wong 2001 [19] (Am J Kidney Dis; abstract opened this repair pass through a PubMed single-record page and a university repository copy, both paraphrased by the fetch tool): one adult man abusing an over-the-counter cough mixture, with mixed normal anion gap hyperchloremic metabolic acidosis, respiratory acidosis and hypokalemia. The authors attribute the metabolic acidosis to ammonium chloride overdose, the respiratory acidosis to respiratory muscle weakness from hypokalemia, and the hypokalemia to a shift of potassium into cells caused by ephedrine and pseudoephedrine. The abstract says ammonium chloride and ephedrine were "probably" in the mixture and names pseudoephedrine only as a cause of the shift, not as a confirmed ingredient; no potassium value, bicarbonate, pH or age is given in the abstract. Sample size 1. Full text not opened.

Mechanism

Present and attributed by the authors: sympathomimetic shift of potassium into cells, possibly indirect through hyperglycaemia and hyperinsulinaemia and possibly direct [8]; the same shift is invoked in [19]. Not measured in either case. Direction: redistribution (excess intracellular, low serum), not a loss of potassium from the body.

Cohort test

[8]: pseudoephedrine was in the case (with a co-ingestant), Tier B (case report). [19]: pseudoephedrine is not confirmed as an ingredient (ephedrine "probably" present; mixture composition not stated), so this record is weaker than [8] and is not independent Tier A confirmation; it is also Tier B. Neither is class extrapolation. Both are acute abuse or overdose settings, so no red or orange criterion is met.

Counter-evidence held on record

Counter-evidence and confounding The co-ingestant, the acute-overdose setting and a single patient make attribution to pseudoephedrine alone uncertain. The authors' own conclusion in [8] is that total body potassium was normal. In [19] the product composition is unconfirmed and ammonium chloride acidosis is a competing explanation for the acid-base picture. Framing caution This is a redistribution finding in overdose, not a potassium deficiency. Potassium intake should not be increased on the basis of this entry; supplementation would be the hazard.

Blood glucose: transient disturbance, mixed small studies

Yellow — Low

See study details

A sympathomimetic effect on glucose is plausible, but one 6-person human study found no post-exercise change and another found a non-significant upward trend; glucose here is a metabolic disturbance, not a nutrient deficiency.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. Yellow

Limits on what this shows

  • Null findings: Bright 1981 [9] is a null result for glucose and insulin. Neither human study measured potassium or any micronutrient.
  • At-risk subgroups: People with diabetes (label advice [1][2]); people on corticosteroids are a hypothesis from the cell study [11], not a clinical finding.

Regulatory status

Both OTC labels list diabetes among conditions to discuss with a doctor before use [1][2]. No glucose effect size is given on the labels.

Population evidence

Bright 1981 [9] (J Clin Pharmacol; abstract via OpenAlex): 6 healthy men, two dose levels (including 120 mg), at rest and during submaximal treadmill exercise; no effect on post-exercise blood glucose and insulin. Pritchard-Peschek 2010 [10] (Int J Sport Nutr Exerc Metab; abstract via OpenAlex): 6 trained men, 180 mg pseudoephedrine against placebo, double-blind crossover; norepinephrine rose in the pseudoephedrine trial only (p =.04) and post-exercise blood glucose showed a trend toward higher values (p =.06); no effect size or CI was reported in the abstract. A 2021 review states that pseudoephedrine "increases blood glucose levels" citing two references that were not opened [7].

Mechanism

Present in Tier B form: in rat hepatocytes, ephedrine, pseudoephedrine and phenylpropanolamine caused little or no change in glucose output in normal cells, but raised it significantly in cells from dexamethasone-pretreated rats (Pharmacology 1986; abstract read via OpenAlex, effect described by authors as weak and probably indirect) [11].

Cohort test

Pseudoephedrine was the studied drug in [9], [10] and [11]. Tier A for [9] and [10] (primary human studies, very small); Tier B for [11]. The review [7] is Tier C/D for this claim because its sources were not opened.

Counter-evidence held on record

Counter-evidence and confounding Exercise itself raises catecholamines and glucose; both studies are tiny, acute, in healthy fit men, and the results disagree. Neither is a test of a dietary glucose or insulin-resistance effect in people with diabetes. Framing caution Glucose is not a nutrient deficiency, and this entry does not imply any dietary change. It is a context flag for people with diabetes under the label's existing advice.

Urinary pH modifiers, including vitamin C and fruit juice: nutrient-to-drug interaction, not depletion

Yellow — Low

See study details

Acidifying or alkalinizing the urine changes how fast pseudoephedrine leaves the body; the direction is agent affecting the drug, and no source opened tested dietary vitamin C or fruit juice.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. Yellow

Limits on what this shows

  • Null findings: None for diet. No fruit juice or dietary vitamin C study with pseudoephedrine was located. A drug-interaction page lists caffeine as the only food or beverage interaction for pseudoephedrine [21].
  • At-risk subgroups: People using sodium bicarbonate or other alkalinizing agents regularly (more exposure, longer half-life) and high-dose acidifiers (shorter effect). Renal impairment (label and review advice [2][5]).

Regulatory status

The OTC labels retrieved contain no urine-pH or vitamin C statement [1][2].

Population evidence

Kuntzman 1971 [6] (Clin Pharmacol Ther; abstract via OpenAlex, reconstructed from an OCR-damaged index): 3 normal volunteers; plasma half-life 5.2, 7.6 and 8.0 hours; when urine was acidified with ammonium chloride the half-life decreased markedly, and when alkalinized with sodium bicarbonate it increased. Exact post-treatment values were not in the record. Kanfer 1993 [5] (pharmacokinetic review abstract): elimination predominantly renal and pH dependent, half-life about 6 hours. A 2021 review lists urine alkalinizers such as sodium bicarbonate as increasing reabsorption, with a stated risk of seizures, anxiety and tachycardia (table entry without a citation) and does not mention ascorbic acid or any named acidifier [7]. Chua 1989 [23] (Biopharm Drug Dispos; abstract via Crossref and OpenAlex, paraphrased) is a review of non-prescription sympathomimetics that states renal excretion of these basic agents depends on urinary pH; it is Tier B/C for this claim (a class-level review that does not isolate pseudoephedrine in the abstract) and reports no vitamin C or diet data. A Tier D reference page names ascorbic acid as an acidifier that increases excretion, but its primary source was not opened [20].

Mechanism

Present: the largely unchanged drug undergoes urine-pH-dependent renal elimination, with faster loss in acidic and slower loss in alkaline urine (stated in [5][6][7]). Whether ordinary dietary vitamin C, fruit juice or a high-protein or vegetarian diet shifts urine pH enough to matter for pseudoephedrine has not been measured in any source opened.

Cohort test

Pseudoephedrine was in the cohort in [6] (Tier A for the drug's own pharmacokinetics). Not a nutrient measurement; the only nutrient inference (vitamin C, juice) is mechanistic only and is Tier B/C at most.

Counter-evidence held on record

Counter-evidence and confounding Half-life shifts were shown with ammonium chloride and sodium bicarbonate at pharmacologic doses in 3 people, not with food. Dose size and the clinical consequence for decongestant effect are unmeasured; a direct relationship between plasma concentration and decongestant effect has not been established [5]. Framing caution Rule 4: this is a nutrient or agent affecting the drug (a timing and exposure interaction), not pseudoephedrine depleting a nutrient. No separation interval or supplement advice can be derived from the sources opened. Do not stop or change vitamin C or diet on this basis.

Antacids and kaolin: timing interaction, agent-to-drug

Yellow — Low

See study details

Aluminum hydroxide gel raised pseudoephedrine absorption in humans and kaolin lowers its absorption rate; this is an effect on the drug, not on any mineral.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. Yellow

Limits on what this shows

  • Null findings: None located. No study measuring the magnitude (Cmax, AUC) was opened.
  • At-risk subgroups: Users taking antacids or kaolin-pectin products at the same time.

Regulatory status

The OTC labels retrieved do not mention antacids or kaolin [1][2].

Population evidence

Lucarotti 1972 [16] (J Pharm Sci): human study whose title reports enhanced pseudoephedrine absorption with concurrent aluminum hydroxide gel. Only the title and metadata were retrieved: the abstract field is empty in both the OpenAlex record and the PubMed record (re-checked this repair pass; the PubMed MeSH terms list urine, intestinal absorption and hydrogen-ion concentration, which indicate a urinary-excretion design but report no values), so effect size, sample size and CI are not available and the paper is not otherwise relied on. A 2021 review states that antacids such as aluminium hydroxide and proton pump inhibitors increase the pseudoephedrine absorption rate and kaolin clay decreases it by adsorption (text cites three references not opened) [7].

Mechanism

Present for the drug: altered gastric emptying or adsorption changing the rate of absorption. Not a depletion mechanism for aluminum, magnesium or calcium.

Cohort test

Pseudoephedrine was the studied drug in [16] (title only). Class reviews are not used.

Counter-evidence held on record

Counter-evidence and confounding Rate of absorption is not total absorption; the clinical consequence (faster peak) is unquantified in the sources opened. Framing caution Rule 4: direction is antacid to drug. This entry gives no separation interval because none was found in an opened source, and it is not a mineral depletion claim.

Dietary intake via appetite suppression: weight outcome null

Yellow — Low

See study details

A centrally mediated appetite reduction is plausible for an indirect sympathomimetic, but no source opened measured food or nutrient intake, and a 12-week trial of 120 mg/day showed no weight difference from placebo.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. Yellow

Limits on what this shows

  • Null findings: Greenway 1999 [12], as summarized in [13], is the null result for weight and for patient-reported appetite (secondary account). A weight outcome is not an intake outcome (Hard Rule 2), so it weighs against clinically meaningful appetite suppression without proving no change in intake.
  • At-risk subgroups: Frail or older adults with low baseline intake; people using pseudoephedrine continuously or as an off-label appetite suppressant [7]. Hypothesis only.

Regulatory status

Not mentioned on the OTC labels retrieved [1][2].

Population evidence

Greenway 1999 [12] (Obes Res; abstract via OpenAlex, reconstructed): one of three trials compared 120 mg/day pseudoephedrine with placebo for 12 weeks in 72 obese subjects; pseudoephedrine did not differ from placebo in weight loss, and the authors concluded it is not an effective weight-loss drug at the doses studied. Group weights and CIs were not in the abstract record. The 2021 review [13] (open-access full text opened this repair pass) summarizes the same trial as a slow-release 120 mg/day formulation in 72 patients for 12 weeks, baseline BMI 29.2 kg/m2 against 28.5 kg/m2, end-of-study weight loss of 4.6 kg (pseudoephedrine) against 4.5 kg (placebo), no statistical significance at any intermediate point, and "no difference in appetite reported by patients in the two subgroups"; per-arm n and p values are not given, and this is a secondary account (the primary full text was not opened). A 2021 narrative review attributes appetite reduction to inhibition of hypothalamic paraventricular neurons and calls clinical data limited and the risk-benefit profile unbalanced [13]. A 2021 review lists "decreased appetite" as a digestive effect in 5% of users (table entry, no citation) [7].

Mechanism

Present, Tier B/C: central appetite suppression through sympathomimetic action (mechanism class H, changed intake) [13]. Intake of any nutrient was not measured.

Cohort test

Pseudoephedrine was the studied drug in [12] (Tier A for weight). [13] and [7] are narrative reviews (Tier C for the intake claim).

Counter-evidence held on record

Counter-evidence and confounding The trial population was obese subjects; findings may not transfer to short-term cold-season use or to people with low baseline intake. No intake diary or nutrient intake was reported in the abstract record. Framing caution No nutrient deficiency is claimed. Do not read this as a reason to supplement or to use pseudoephedrine for weight control; the 2021 review advises against prescribing it to obese patients [13].

The five body-system areas

Each finding is counted once, in a single area. Where a study is mentioned in a second area it is context only.

Mitochondrial Burden

Each finding below is counted once, in this area only.

Mitochondrial burden: reverse direction in a disease model; ephedrine class extrapolation points the other way

Yellow — Low

See study details

In smoke-injured lung cells and rats, pseudoephedrine restored mitochondrial structure and reduced mitochondrial ROS; no human data exist, and the related alkaloid ephedrine damaged mitochondria in liver-derived cells.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. Yellow

Limits on what this shows

  • Null findings: None. No human study of mitochondrial function was located.
  • At-risk subgroups: None established.

Regulatory status

Not mentioned on the OTC labels retrieved [1][2].

Population evidence

Wu 2026 [14] (Biomol Ther; abstract read via OpenAlex, paraphrased; full text not opened): a rat COPD model (cigarette smoke plus LPS) and BEAS-2B bronchial epithelial cells exposed to cigarette smoke extract, treated with pseudoephedrine. Pseudoephedrine restored mitochondrial structure (visible cristae), reduced excessive mitochondrial fission and reactive oxygen species, and the effect depended on the PI3K/AKT/mTOR pathway (an agonist blunted it). Doses, group sizes and effect sizes were not in the abstract record. CLASS EXTRAPOLATION: Lee 2017 [15] (J Toxicol Sci) studied ephedrine, not pseudoephedrine, in human hepatic stellate cells (LX-2): mitochondrial oxidative stress, membrane depolarization, swelling, inhibited biogenesis and lower mtDNA copy number. Pseudoephedrine was not in that cohort, so it is Tier C for this drug and capped at yellow.

Mechanism

Present in both directions, in different systems: protective restoration under injury [14]; ephedrine-induced Parkin-dependent mitophagy [15]. Which applies to pseudoephedrine in healthy human tissue is unknown.

Cohort test

[14] pseudoephedrine in the cohort (Tier B, cell and rat). [15] ephedrine only: CLASS EXTRAPOLATION, pseudoephedrine not in the cohort.

Counter-evidence held on record

Counter-evidence and confounding The two studies use different compounds, cell types and conditions, and each abstract came through a summarizing fetch tool. A protective effect in a smoke-injury model does not show a protective effect in uninjured tissue. Framing caution This is not a claim of mitochondrial damage or protection in people. It is a research flag, and the protective result must not be marketed.

Oxidative Stress

Each finding below is counted once, in this area only.

Oxidative stress: reverse direction in a disease model

Yellow — Low

See study details

In the same smoke-injury rat and cell study, pseudoephedrine lowered ROS and raised superoxide dismutase; no human redox marker data were found.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. Yellow

Limits on what this shows

  • Null findings: None located. No human MDA, glutathione, TAC or antioxidant-enzyme study with pseudoephedrine was found.
  • At-risk subgroups: None established.

Regulatory status

Not mentioned on the OTC labels retrieved [1][2].

Population evidence

Wu 2026 [14]: in BEAS-2B cells pseudoephedrine reduced reactive oxygen species; in rats it raised SOD and lowered pro-inflammatory factors, with oxidative stress assessed by ELISA, immunohistochemistry and Western blot. Doses and sample sizes not in the abstract record. CLASS EXTRAPOLATION: ephedrine caused mitochondrial oxidative stress in LX-2 cells [15]; pseudoephedrine not in that cohort, Tier C.

Mechanism

Reported: PI3K/AKT/mTOR signaling in the smoke-injury model [14]. Direct antioxidant chemistry of pseudoephedrine was not shown.

Cohort test

[14] Tier B with pseudoephedrine; [15] ephedrine only, CLASS EXTRAPOLATION.

Counter-evidence held on record

Counter-evidence and confounding Same limits as the mitochondrial entry: the effect is measured against injury, not against uninjured controls in humans. Evidence is shared with the mitochondrial and ATP entries (see Overlap map). Framing caution Not an antioxidant claim and not a recommendation to take antioxidants. Supplement advice is not made.

Copper and Iron Balance

Copper and iron are assessed separately. Nothing here is counted twice.

Copper

Not graded — disclosed evidence gap

See study details

No evidence was found that pseudoephedrine alters copper status, absorption or ceruloplasmin.

Full detail, limits and 1 references

What the grade means here: Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result. Ungraded

Limits on what this shows

  • Why no grade: Dual condition met: no Tier B or C evidence for copper and no circulating copper claim for pseudoephedrine was found in the limited consumer audit (Wikipedia, a drug-interaction page, one open-access review). This is a disclosed gap, not a finding of safety. Graded independently of Iron (Hard Rule 7). Re-check when PubMed listing access is reliable, using copper-only and ceruloplasmin-only phrasings. Classification: probable genuine gap (no signal anywhere, and the label, compendium and interaction sources are silent), with a residual tooling limit.

What was searched

PubMed listing "pseudoephedrine (iron OR copper OR zinc OR magnesium OR ferritin)": 18 results, page 1 of 2 read (10 records): common-cold treatment reviews, a Maxing Shigan Decoction study, a bitterness-suppression paper, a chromatography paper; none measured copper status. One record is a synthetic copper complex of pseudoephedrine hydrochloride with DNA-interaction testing (PMID 30942140, title only, not opened [22]), which is coordination chemistry in a flask and not a physiological copper-handling finding. Page 2 (8 records) was not read. DailyMed OTC labels [1][2]: no copper statement. Drug-interaction page [21]: caffeine only. Repair pass 2026-10-08: WebSearch (working again) "pseudoephedrine serum iron OR ferritin OR serum copper OR ceruloplasmin effect" returned patent and animal ceruloplasmin pages; the two journal pages opened (a 1973 swine and rheumatoid arthritis ceruloplasmin and hypoferremia paper; a 1969 rat zinc-induced copper deficiency collection) do not mention pseudoephedrine or ephedrine and were not used. No pseudoephedrine copper, ceruloplasmin or serum copper study was found.

Channel outcomes

PubMed HTML search listings opened intermittently via WebFetch; many attempts returned HTTP 429. Direct curl and Python HTTP to PubMed, Crossref, OpenAlex and others are blocked by policy and were not used. OpenAlex single-record lookups and DailyMed label pages opened. WebSearch had no remaining budget, so no open-web query was possible. Mixed result: a clean zero on the one PubMed listing read plus tooling limits on the rest. Repair pass: one WebSearch phrasing (combined with iron) completed with no relevant hit; PubMed listing attempts that day returned HTTP 429 and were not repeated. Copper-specific phrasings on PubMed (ceruloplasmin, serum copper alone) were not completed.

Iron

Not graded — disclosed evidence gap

See study details

No evidence was found that pseudoephedrine alters iron absorption, ferritin or transferrin saturation.

Full detail and limits

What the grade means here: Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result. Ungraded

Limits on what this shows

  • Why no grade: Dual condition met: no Tier B or C evidence for iron and no circulating iron claim was found. Not a finding of safety. Independent of Copper (Hard Rule 7). Classification: probable genuine gap with a residual tooling limit; re-check with iron-only PubMed phrasings.

What was searched

Same PubMed listing as Copper (ferritin and iron included): no iron-status study. DailyMed labels [1][2]: no iron statement. Antacid interaction data [7][16] concern pseudoephedrine absorption, not iron absorption. Drug-interaction page [21]: caffeine only. Repair pass 2026-10-08: the same WebSearch phrasing as Copper (ferritin and serum iron included) returned no pseudoephedrine iron study; see Copper for the pages opened. A cough-mixture-abuse case series from Hong Kong reports haemoglobin and red-cell folate in three abusers whose toxicology showed ephedrine (not pseudoephedrine) plus other agents [27]; it measured no iron indices, is a mixed-substance abuse setting and is not used as iron evidence.

Channel outcomes

PubMed HTML search listings opened intermittently via WebFetch; many attempts returned HTTP 429. Direct curl and Python HTTP to PubMed, Crossref, OpenAlex and others are blocked by policy and were not used. OpenAlex single-record lookups and DailyMed label pages opened. WebSearch had no remaining budget, so no open-web query was possible. Mixed result: clean zero on the one PubMed listing read; tooling-limited elsewhere. Repair pass: one WebSearch phrasing completed with no relevant hit; iron-only PubMed phrasings (serum iron, ferritin, transferrin saturation, iron absorption) were not completed because of HTTP 429.

Gut Microbiome Risk

Each finding below is counted once, in this area only.

Gut microbiome risk

Not graded — disclosed evidence gap

See study details

No study of pseudoephedrine and gut microbiota composition, diversity or function was found.

Full detail and limits

What the grade means here: Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result. Ungraded

Limits on what this shows

  • Why no grade: Dual condition met: no Tier B or C microbiome source and no circulating microbiome claim found. Ischemic colitis is a clinical outcome and is not filed under this category (Hard Rule 2). The only adjacent literature is whole-Ephedra-herb extract work, which does not isolate the drug. Re-check with 16S and fecal microbiota phrasings when PubMed listing access improves.

What was searched

PubMed "pseudoephedrine gut microbiota": 0 results. PubMed "pseudoephedrine microbiome": 1 record, a plant study of Ephedra sinica endophytes (PMID 37556062), which concerns the herb's own microbes, not human gut microbiota. A third phrasing (dysbiosis, 16S, fecal microbiota, Clostridioides) hit a 429 and was not read. Ischemic colitis case reports and the 2023 systematic review [17] describe a vascular colonic injury and were not treated as microbiome evidence. Repair pass 2026-10-08: PubMed "pseudoephedrine dysbiosis": 0 results (the page states no results were found). PubMed "pseudoephedrine 16S", "pseudoephedrine fecal microbiota" and the combined dysbiosis/16S/fecal query were refused with HTTP 429 and not read. WebSearch "pseudoephedrine gut microbiota dysbiosis 16S rRNA fecal" and "pseudoephedrine intestinal flora OR gut microbiome" returned no pseudoephedrine study; one Frontiers 2019 paper opened (Corydalis saxicola alkaloids in antibiotic-induced dysbiosis) and one 1994 ceftibuten paper opened do not mention pseudoephedrine and were not used. A WebSearch on Ephedra and microbiota found two Ephedra sinica whole-herb studies that were opened: a mouse diet-induced obesity study of a water extract at 150 mg/kg/day (n 6 to 8 per group, 8 weeks; Firmicutes/Bacteroidetes ratio fell from 1.22 to 0.61, with the 1.22 figure being the high-fat-diet group) [24] and a before-and-after study of 4 g/day extract in obese Korean women (participant number not stated on the page read) [25]. Neither names, quantifies or isolates pseudoephedrine (the mouse paper gives no alkaloid amounts and the human page gives none), the preparation is a whole-herb extract with many constituents, and pseudoephedrine was not in either cohort as a defined exposure. They are therefore not Tier B or C evidence for this drug and are not graded; they are recorded here so a later reviewer does not repeat the search.

Channel outcomes

PubMed HTML search listings opened intermittently via WebFetch; many attempts returned HTTP 429. Direct curl and Python HTTP to PubMed, Crossref, OpenAlex and others are blocked by policy and were not used. OpenAlex single-record lookups and DailyMed label pages opened. WebSearch had no remaining budget, so no open-web query was possible. Original pass: two phrasings completed (both empty or irrelevant), one blocked. Repair pass: one further PubMed phrasing completed (0 results), two blocked by HTTP 429, and two WebSearch phrasings completed with no pseudoephedrine-specific record. Note that a PubMed fetch with the format=pubmed parameter returned a 404 for the zero-result query, so a 404 on that endpoint is probably an empty result, not a missing page. Mixed: a probable true gap plus residual tooling limits.

Oxygen and ATP Output

Oxygen delivery and ATP production are assessed separately. Nothing here is counted twice.

ATP production: reverse direction in injured cells, no human data

Yellow — Low

See study details

Pseudoephedrine raised ATP levels in smoke-extract-injured bronchial epithelial cells; no study measured ATP in people or in uninjured tissue.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. Yellow

Limits on what this shows

  • Null findings: None located.
  • At-risk subgroups: None established.

Regulatory status

Not mentioned on the OTC labels retrieved [1][2].

Population evidence

Wu 2026 [14]: in BEAS-2B cells exposed to cigarette smoke extract, pseudoephedrine increased ATP (and ZO-1) levels measured with mitochondrial function kits. Doses, replicate numbers and effect sizes not in the abstract record. No ephedrine ATP result was opened. A circulating consumer notion that the drug relieves fatigue refers to central stimulation [7] and is not an ATP measurement.

Mechanism

Present only as restoration of injured mitochondria [14]; no direct effect on oxidative phosphorylation in healthy cells was shown.

Cohort test

[14] pseudoephedrine in cohort (Tier B, cells). Kept independent of Mitochondrial burden and Oxygen delivery/utilization (Hard Rule 7).

Counter-evidence held on record

Counter-evidence and confounding One in vitro result from one group, abstract only. It is not a finding of increased ATP in people. Framing caution No energy or fatigue claim is supported by this entry.

Oxygen delivery/utilization

Not graded — disclosed evidence gap

See study details

No evidence was found that pseudoephedrine lowers hemoglobin, red-cell mass, arterial oxygenation or tissue oxygen delivery through any route independent of its hemodynamic pharmacology.

Full detail and limits

What the grade means here: Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result. Ungraded

Limits on what this shows

  • Why no grade: Dual condition met: no Tier B or C evidence and no circulating oxygen-carrying claim found. The drug's vasoconstrictor and cardiovascular effects are its intended pharmacology, not an oxygen-delivery deficiency (Hard Rule 2). Independent of ATP production (Hard Rule 7). Classification: probable genuine gap with a residual tooling limit (methemoglobin and hemolysis PubMed queries unread); re-check those two single-phrase queries first.

What was searched

PubMed "pseudoephedrine (methemoglobin OR hemolysis OR anemia OR hemoglobin)": 12 results, page 1 of 2 read. Records were priapism papers (pseudoephedrine used as treatment in sickle cell disease, an indication, not a drug effect on hemoglobin), anti-doping and a 1965 hemodynamic paper (not opened). None measured hemoglobin, hematocrit or oxygen delivery as an outcome of pseudoephedrine. OTC labels [1][2]: no hematologic adverse-effect statement. Repair pass 2026-10-08: WebSearch "pseudoephedrine methemoglobinemia OR hemolytic anemia OR hemolysis case report" returned only methemoglobinemia and G6PD case reports without pseudoephedrine in the titles (not opened, so not used); "pseudoephedrine hemoglobin hematocrit red blood cell effect study" returned patents and a red-cell-infusion athletic paper unrelated to the drug (not used). A WebSearch on oxygen saturation found two pseudoephedrine sleep records, both opened: a 2021 pilot crossover trial of pseudoephedrine 120 mg plus diphenhydramine 50 mg in 10 adults with obstructive sleep apnoea [26] and a ClinicalTrials.gov record of pseudoephedrine 240 mg/day in 34 adults with allergic rhinitis and poor sleep [28]. [26] reports apnoea-hypopnoea index (21.6 against 37.9 events/h in the page read) and airway collapsibility, with no oxygen saturation result on the page read, and tests a combination; [28] lists sleep questionnaires as outcomes and has no oxygen outcome and no posted data. Neither measures hemoglobin or oxygen delivery, and an apnoea index is a clinical outcome (Hard Rule 2); both are excluded. The Hong Kong cough-mixture case series [27] lists haemoglobin of 154, 111 and 108 g/L in three abusers whose toxicology showed ephedrine plus other agents; pseudoephedrine was not detected, so it is outside the cohort and not used.

Channel outcomes

PubMed HTML search listings opened intermittently via WebFetch; many attempts returned HTTP 429. Direct curl and Python HTTP to PubMed, Crossref, OpenAlex and others are blocked by policy and were not used. OpenAlex single-record lookups and DailyMed label pages opened. WebSearch had no remaining budget, so no open-web query was possible. Mixed: a clean zero on the page read, with 2 records on page 2 unread. Repair pass: PubMed single-phrase queries "pseudoephedrine methemoglobin" (attempted twice, spaced several minutes apart) and "pseudoephedrine hemolysis" were refused with HTTP 429 and not read; three WebSearch phrasings completed with no pseudoephedrine hematologic or oxygenation record.

Claims checked and not supported

These circulate online for this medication. They are listed here only so they can be answered, never as findings, and they are not graded.

A claim with no supporting evidence is not necessarily disproven. Where evidence actually argues against a claim, that is stated below.

  • Weight loss and "slimming agent" benefit (a claim about efficacy, separate from the intake entry)

    Where it comes from: Use of Ephedra products and pseudoephedrine as slimming agents and appetite reducers, described in the 2021 review [7] and a reference page [20].

    Why it fails: The only placebo-controlled trial opened, 120 mg/day for 12 weeks in 72 obese subjects, found no difference from placebo in weight loss, and the authors concluded it is not an effective weight-loss drug [12]. A 2021 review concludes that prescribing it to obese patients is unreasonable because of limited data and cardiovascular and central nervous system risk [13]. Weight is also an outcome, not a nutrient.

How the body handles this medication

Metabolism and enzymes
Not appreciably metabolized: about 1 to 6% is N-demethylated in the liver to norpseudoephedrine (cathine) [7]; compendia (AHFS via HSDB) give under 1% to an inactive metabolite [4]. No CYP450 enzyme is named in the labels retrieved, and no induction or inhibition is stated [1][2].[4][7]; labels [1][2]
Elimination
Mainly renal and unchanged: 43 to 96% of a dose in urine across sources [7]; 55 to 96% in AHFS via HSDB [4]; a volunteer study quoted in HSDB reports 72.2% unchanged (primary not opened) [4]. Urinary peaks at 2 to 6 hours; cleared by about 24 to 48 hours (same HSDB quotation) [4].[4][7]
Half-life and urine pH
Plasma half-life 5.2, 7.6 and 8.0 hours in 3 volunteers; it fell markedly after ammonium chloride (urine acidified) and rose after sodium bicarbonate (urine alkalinized) [6]. A pharmacokinetic review gives about 6 hours and calls elimination predominantly renal and pH dependent [5]. A 2021 review gives a 3 to 16 hour range [7].[5][6][7]
Absorption
Readily and completely absorbed; peak concentration 0.5 to 2 hours; apparent volume of distribution 2.6 to 5.0 L/kg [5]. No absorption transporter is named in the sources retrieved.[5]
Renal and special populations
Labels advise people with kidney or liver disease to ask a doctor (dose may differ) [2]. The pharmacokinetic review says to use caution in renal impairment [5]. The Sudafed OTC label states not for children under 6 and asks pregnant or breastfeeding users to consult a health professional [1]. No effect on renal tubular handling of water or electrolytes is described in the labels retrieved.[1][2][5]
Food, antacid and mineral interactions
Label: do not use with an MAOI or within 2 weeks of stopping one [1]. A review states that aluminium hydroxide antacids increase the pseudoephedrine absorption rate, kaolin decreases it, and urine alkalinizers (sodium bicarbonate) increase its reabsorption [7]. A 1972 human study title reports enhanced absorption with aluminum hydroxide gel (abstract not retrieved) [16]. No vitamin, mineral or food interaction is listed on the OTC labels.[1][7][16]

What the research says is worth watching

General information from the medication label and the studies above. It is not personal medical advice, and any change belongs with your prescriber.

  • Clinical outcome, not a nutrient

    Blood pressure and heart rate

    Pooled trials show a small average rise (systolic about 1 mm Hg, heart rate about 3 beats/min), larger with higher doses and immediate-release forms [18]. Labels advise asking a doctor first with heart disease or high blood pressure [1]. This is the drug's own pharmacology and is not filed as a nutrient finding.

  • Lab / overdose or symptoms

    Serum potassium

    Worth checking in overdose or with unexplained weakness, palpitations or arrhythmia (the case in [8]). Routine potassium testing at labeled doses is not supported by any source opened. The finding is a redistribution; potassium supplements are not indicated by this review.

  • Lab / people with diabetes

    Blood glucose

    Labels list diabetes among conditions to check with a doctor before use [1][2]. Extra glucose checks while taking it are a reasonable prompt, based on label advice and a possible trend [10], not an established effect [9].

  • Timing and interaction

    Urine pH modifiers and antacids

    Tell a pharmacist about regular use of sodium bicarbonate, ammonium chloride-type acidifiers, high-dose vitamin C, antacids or kaolin products [6][7]. No separation interval has been established in the sources opened. No change to diet or vitamins is recommended by this review.

  • Intake and weight

    Appetite and food intake

    For regular, long-term or off-label use, watch for unintended weight loss or reduced eating, especially in older adults [7][13]. Evidence of a nutrient effect is absent.

  • Warning signs

    Abdominal pain with rectal bleeding

    Ischemic colitis is rare but reported with pseudoephedrine, including recurrent episodes in a systematic review of 18 case reports [17]. This calls for urgent medical assessment and stopping the drug, not nutrient testing.

  • Special populations

    Pregnancy, pediatrics, renal impairment

    Label: not for children under 6 on the Sudafed OTC label; ask a health professional in pregnancy or breastfeeding; people with kidney or liver disease should ask a doctor about dosing [1][2]. The pharmacokinetic review advises caution in renal impairment and notes elimination may be rapid in children [5].

Overlap map, to prevent double counting

  • Mitochondrial burden

    Shares evidence with: Oxidative stress; ATP production

    Note: All three rest on the same single study (Wu 2026, rat and BEAS-2B COPD model [14]) and the same ephedrine class-extrapolation study [15]. One abstract, one group, one disease model. Not three independent confirmations.

  • Potassium

    Shares evidence with: Blood glucose

    Note: The case report [8] attributes the potassium shift to hyperglycaemia and hyperinsulinaemia, a mechanism shared with the glucose entry. The glucose studies [9][10] did not measure potassium. Shared mechanism, no shared data. The second potassium record [19] (cough-mixture abuse) is a separate patient but also an acute abuse setting with unconfirmed pseudoephedrine content, so [8] and [19] are not two independent confirmations of a therapeutic-dose effect.

  • Urinary pH modifiers

    Shares evidence with: Antacids and kaolin

    Note: Both are agent-to-drug interactions that change pseudoephedrine exposure and both draw on the same 2021 review table [7]; the pH entry also cites the 1989 review [23]. The pH entry also rests on [5][6]; the antacid entry also rests on [16] (title only). Neither is a depletion.

  • Dietary intake via appetite suppression

    Shares evidence with: Fails verification: weight-loss efficacy

    Note: Both use the Greenway trial [12] and the Munafo review [13]. The intake entry concerns possible reduced eating; the white row concerns an efficacy claim. One data source, two framings.

  • Copper

    Shares evidence with: Iron

    Note: No shared source. Both are ungraded after the same combined PubMed listing query that covered both; the gap is searched once, not twice independently (the repair-pass WebSearch phrasing again combined both). Graded separately per Hard Rule 7.

  • Oxygen delivery/utilization

    Shares evidence with: ATP production; Mitochondrial burden

    Note: No shared evidence. Oxygen delivery is ungraded; the ATP and mitochondrial entries rest on [14]. Kept as separate entries (Hard Rule 7).

  • Gut microbiome risk

    Shares evidence with: None

    Note: No shared source. Ischemic colitis [17] is a vascular outcome and is not counted as microbiome evidence. The Ephedra whole-herb microbiota studies [24][25] are recorded as examined and excluded and support no entry.

All references used above
  1. SUDAFED SINUS CONGESTION (pseudoephedrine HCl 30 mg tablet), DailyMed OTC label, Kenvue Brands LLC. — Regulatory label (Tier A). Drug Facts: indications, MAOI contraindication, diabetes/hypertension/heart disease advice, pediatric limits. No clinical pharmacology section on the page. Read through a summarizing fetch tool.
  2. Cetirizine hydrochloride and pseudoephedrine hydrochloride extended-release tablets 5 mg/120 mg, DailyMed OTC label. — Regulatory label (Tier A), combination product. No clinical pharmacology or drug-interaction section on the page; kidney/liver disease advice and no nutrient statements. Read through a summarizing fetch tool.
  3. WHO Collaborating Centre, ATC/DDD Index: R01BA02 pseudoephedrine. — Reference index. Group R01BA Sympathomimetics, R01B nasal decongestants for systemic use.
  4. PubChem compound 7028 (pseudoephedrine), PUG View extracts: Metabolism/Metabolites and Drug Warnings headings (HSDB, citing AHFS Drug Information 2007; DrugBank; T3DB). — Established pharmacology compilation (Tier B). Metabolism under 1%; 55 to 96% excreted unchanged; a volunteer study (Tseng 2006, PMID 15885945) is quoted but the primary was not opened. Read through a summarizing fetch tool.Secondary compilation; primary studies quoted in it were not opened.
  5. Kanfer I, Dowse R, Vuma V. Pharmacokinetics of oral decongestants. Pharmacotherapy 1993;13(6 Pt 2):116S-128S. — Pharmacokinetic review (Tier B). PMID 7507589; DOI 10.1002/j.1875-9114.1993.tb02780.x. Abstract only, via OpenAlex lookup (paraphrased by the fetch tool).
  6. Kuntzman RG, Tsai I, Brand L, Mark LC. The influence of urinary pH on the plasma half-life of pseudoephedrine in man and dog and a sensitive assay for its determination in human plasma. Clin Pharmacol Ther 1971;12(1):62-67. — Human volunteer pharmacokinetics (Tier A for the drug's own kinetics), 3 volunteers. PMID 5541135; DOI 10.1002/cpt197112162. Abstract reconstructed from an OCR-damaged OpenAlex index.
  7. Glowacka K, Wiela-Hojenska A. Pseudoephedrine - benefits and risks. Int J Mol Sci 2021;22(10):5146. — Narrative review (Tier C for the individual claims). PMID 34067981; DOI 10.3390/ijms22105146. Full open-access text read through a summarizing fetch tool; table entries without citations are noted as such.Narrative review without drug-level stratification; cited references not opened.
  8. Compartmental shift of potassium - a result of sympathomimetic overdose. Aust N Z J Med 1978;8(2):180-183. — Case report, 1 patient (Tier B). PMID 277167. Abstract read via OpenAlex (paraphrased by the fetch tool); PubMed record page itself was rate-limited and not opened. Authors not captured in retrieval.Pseudoephedrine co-ingested with choline theophyllinate.
  9. Bright TP, Sandage BW, Fletcher HP. Selected cardiac and metabolic responses to pseudoephedrine with exercise. J Clin Pharmacol 1981;21(11):488-492. — Human crossover-type exercise study, 6 healthy men, two dose levels (Tier A). PMID 7037866; DOI 10.1002/j.1552-4604.1981.tb05655.x. Abstract via OpenAlex (reconstructed).
  10. Pritchard-Peschek KR, Jenkins DG, Osborne MA, Slater GJ. Pseudoephedrine ingestion and cycling time-trial performance. Int J Sport Nutr Exerc Metab 2010;20(2):132-138. — Randomized double-blind crossover, 6 trained men, 180 mg (Tier A). PMID 20479486; DOI 10.1123/ijsnem.20.2.132. Abstract via OpenAlex (paraphrased).
  11. Parker VD, Fletcher P (authors per OpenAlex). Effects of noncatechol sympathomimetics on glucose output by hepatocytes from normal and dexamethasone-treated rats. Pharmacology 1986;33(5):279-285. — In vitro rat hepatocyte study with ephedrine, pseudoephedrine and phenylpropanolamine (Tier B). PMID 3797466; DOI 10.1159/000138227. Abstract via OpenAlex (paraphrased). OpenAlex lists 2008 as the year; the PubMed listing and volume indicate 1986.
  12. Greenway FL, Heber D, Raum WJ, Morales S. Double-blind, randomized, placebo-controlled clinical trials with non-prescription medications for the treatment of obesity. Obes Res 1999;7(4):370-378. — Three randomized trials (Tier A for weight); pseudoephedrine arm 120 mg/day, 72 obese subjects, 12 weeks. PMID 10440593; DOI 10.1002/j.1550-8528.1999.tb00420.x. Abstract via OpenAlex (reconstructed); numerical weight changes not in the record.
  13. Munafo A, Frara S, Perico N, et al. In search of an ideal drug for safer treatment of obesity: the false promise of pseudoephedrine. Rev Endocr Metab Disord 2021;22(4):1013-1025. — Narrative review (Tier C for the claim). PMID 33945051; DOI 10.1007/s11154-021-09658-w. Abstract via OpenAlex (paraphrased); repair pass: full text opened through the Springer article page (paraphrased by the fetch tool), which gave the Greenway weight figures quoted above.
  14. Wu L, Chen F, Zhang H, et al. Pseudoephedrine improves chronic obstructive pulmonary disease by regulating airway senescence and mitochondrial function through the PI3K/AKT/mTOR axis. Biomol Ther (Seoul) 2026;34(3):589-607. — Rat COPD model and BEAS-2B cells (Tier B). PMID 42059030; DOI 10.4062/biomolther.2025.190. Abstract only via OpenAlex (paraphrased); no doses or sample sizes in the record; full text not opened.
  15. Lee AY, Jang Y, Hong SH, et al. Ephedrine-induced mitophagy via oxidative stress in human hepatic stellate cells. J Toxicol Sci 2017;42(4):461-473. — In vitro study of ephedrine in LX-2 cells (Tier C for this drug). PMID 28717105; DOI 10.2131/jts.42.461. Abstract via OpenAlex (paraphrased).Excluded cohort: ephedrine only; pseudoephedrine not studied. CLASS EXTRAPOLATION, yellow cap.
  16. Lucarotti RL, Colaizzi JL, Barry H, Poust RI. Enhanced pseudoephedrine absorption by concurrent administration of aluminum hydroxide gel in humans. J Pharm Sci 1972;61(6):903-905. — Human study (Tier A by design). PMID 5046107; DOI 10.1002/jps.2600610615.Title and metadata only; the abstract field was empty in OpenAlex and in the PubMed record (re-checked 2026-10-08). Findings beyond the title were not read.
  17. Goraya MHN, Inayat F, Taj S, et al. Acute ischemic colitis associated with oral decongestant use: a systematic review. J Clin Transl Res 2023;9(3):195. — Systematic review of 18 case reports of pseudoephedrine or phenylephrine ischemic colitis (Tier B/C). PMID 37275581; DOI 10.18053/jctres.09.202303.008. Abstract via OpenAlex (paraphrased; text partly incomplete).Pools pseudoephedrine and phenylephrine cases. Clinical outcome, not a nutrient.
  18. Salerno SM, Jackson JL, Berbano EP. Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis. Arch Intern Med 2005;165(15):1686-1694. — Meta-analysis of 24 randomized placebo-controlled trials (45 arms, 1,285 patients) (Tier A). PMID 16087815; DOI 10.1001/archinte.165.15.1686. Abstract via OpenAlex (paraphrased).Clinical outcome (blood pressure, heart rate), not a nutrient.
  19. Wong KM, Chak WL, Cheung CY, et al. Hypokalemic metabolic acidosis attributed to cough mixture abuse. Am J Kidney Dis 2001;38(2):390-394. — Case report, 1 adult man (Tier B). PMID 11479167; DOI 10.1053/ajkd.2001.26107. Authors per PubMed: Wong KM, Chak WL, Cheung CY, Chan YH, Choi KS, Chau KF, Li CS.Abstract opened 2026-10-08 through a PubMed single-record page and a university repository copy (paraphrased by the fetch tool); full text not opened. Pseudoephedrine named as a cause of the potassium shift, not as a confirmed ingredient; no potassium value in the abstract. Tier B, weak attribution.
  20. Wikipedia. Pseudoephedrine. — Tier D. Used only to locate primary leads and as a circulating-claim origin (appetite suppressant use; urine acidifiers and alkalinizers). Read through a summarizing fetch tool; its reference list was not available.Tier D. Never supports a claim.
  21. Drugs.com. Pseudoephedrine food interactions. — Tier D. Used only for the circulating-claim audit: lists caffeine as the only food or beverage interaction.Tier D. Never supports a claim.
  22. Synthesis, characterization and DNA interaction studies of new copper complex containing pseudoephedrine hydrochloride drug. Nucleosides Nucleotides Nucleic Acids 2019. — PMID 30942140. Seen only as a PubMed listing title.Not opened (title only). Synthetic coordination chemistry; not used as evidence.
  23. Chua SS, Benrimoj SI, Triggs EJ. Pharmacokinetics of non-prescription sympathomimetic agents. Biopharm Drug Dispos 1989;10(1):1-14. — Review (Tier B/C for the urinary pH claim; class-level, pseudoephedrine not isolated in the abstract). PMID 2647163; DOI 10.1002/bdd.2510100102. Abstract via a Crossref DOI lookup and an OpenAlex DOI lookup (paraphrased by the fetch tool); full text not opened.Class-level review; no vitamin C or diet data. Not used for any grade above yellow.
  24. Impact of the herbal medicine, Ephedra sinica Stapf, on gut microbiota and body weight in a diet-induced obesity model. Front Pharmacol 2022. — Mouse study of a whole-herb water extract, 150 mg/kg/day, n 6 to 8 per group (design as read through the fetch tool). PMC9706310; DOI 10.3389/fphar.2022.1042833. Article page opened 2026-10-08.Excluded cohort: pseudoephedrine is not named or quantified; whole-herb extract. Examined and not used.
  25. The anti-obesity effect of Ephedra sinica through modulation of gut microbiota in obese Korean women. J Ethnopharmacol 2014;152(3):532-539. — Before-and-after study of 4 g/day water extract (about 24 g crude herb); participant number not stated on the page read. Institutional repository record opened 2026-10-08.Excluded cohort: pseudoephedrine not mentioned; whole-herb extract. Examined and not used.
  26. Taranto-Montemurro L, Sands S, Azarbarzin A, et al. Impact of cold and flu medication on obstructive sleep apnoea and its underlying traits: a pilot randomized controlled trial. Respirology 2021;26(5):485-492. — Randomized double-blind crossover, 10 adults, one night of pseudoephedrine 120 mg plus diphenhydramine 50 mg against placebo. Institutional repository record opened 2026-10-08 (abstract paraphrased).Combination exposure; apnoea index is a clinical outcome; no oxygen saturation result on the page read. Examined and not used.
  27. Tsang JSK, Au WY. Cough mixture abuse and rhabdomyolysis. Hong Kong Med J 2012;18:68-69. — Case report plus record review of 57 abusers, 3 detailed cases (haemoglobin 154, 111 and 108 g/L; red-cell folate low in all three). Toxicology showed ephedrine in two cases; pseudoephedrine not detected. PDF opened 2026-10-08 (paraphrased by the fetch tool).Excluded cohort: ephedrine and other agents, pseudoephedrine not in the cohort. Examined and not used.
  28. ClinicalTrials.gov NCT00704496: effect of pseudoephedrine on rhinitis and sleep (record via a trial-registry mirror). — Randomized crossover, 34 enrolled, pseudoephedrine 240 mg/day against placebo; outcomes are sleep questionnaires; no posted outcome data. Page opened 2026-10-08.No oxygen or nutrient outcome; no data posted. Examined and not used.