Pseudoephedrine back on shelves: What is it and is it okay to take it a lot?

A law change means cough and cold medicines containing pseudoephedrine are now available at pharmacies. Photo / Dom Thomas, RNZ

By Jogai Bhatt of RNZ

As pseudoephedrine returns to shelves in Aotearoa, many may be asking: what is the drug and why was it banned in the first place?

Flu season is in full swing and many have been hit with head colds and sore throats already.

Now we are in winter and peak sickness season, Kiwis will be flocking to pharmacies for over-the-counter cold and flu medicines - especially those containing pseudoephedrine.

Here’s everything you need to know before you go and buy.

What is pseudoephedrine?

Pseudoephedrine is a decongestant that can be used to treat stuffy noses and relieve sinus pressure. It’s an active ingredient used in many cold and flu medicines, such as Nurofen Cold & Flu, or Sudafed.

In 2011, pseudoephedrine was banned from being sold over the counter for fear it would be used in methamphetamine production. In the years since, medicines containing pseudoephedrine effectively became unavailable in New Zealand.

Peudoephedrine has now returned to New Zealand shelves under the National, ACT, NZ First coalition government. It can now be purchased from pharmacies without a prescription.

Pseudoephedrine is returning to shelves after the new coalition Government agreed to Act leader David Seymour's policy.

What are the alternatives to pseudoephedrine?

Nasal sprays are readily available at supermarkets. But while these work well to reduce congestion over the short-term, long-term use can result in damage to the nasal lining, and ceasing use altogether can have a rebound effect causing more congestion.

Over the years there has also been a big conversation over phenylephrine, a drug touted to do exactly the job pseudoephedrine can.

However, University of Auckland pharmacy lecturer Dr Rhys Ponton disputed this in a 2023 interview with RNZ’s The Detail.

“We saw that the FDA announced the results of a review they’ve conducted which has confirmed what we already knew, in that phenylephrine really is not effective as a decongestant.”

Why is pseudoephedrine so good at making you feel better when you have a cold?

You experience a blocked or stuffy nose when the blood vessels in the cavities of your nose (sinuses) become swollen. Pseudoephedrine works by reducing this swelling, and that helps mucus and air flow more freely.

Many people also report a pleasant feeling throughout their body once they take their meds. This is because pseudoephedrine increases the release of serotonin and dopamine (our happy chemicals).

Pseudoephedrine works by reducing swelling of your sinuses, helping mucus and air flow more freely. Photo / 123rf

Can it be bad for you?

Like all medicines, pseudoephedrine comes with a set of risks. Restlessness, nausea and difficulty sleeping are common side effects. Headaches, increased sweating, and painful urination are less common.

When used properly, pseudoephedrine is not addictive, but when it’s abused, it can be harmful. The most common misuse of pseudoephedrine is when it’s converted into an ingredient that is used to make meth and “bath salts” (psychoactive drugs similar to cocaine or MDMA). Some people may also misuse it as an illegal stimulant to increase alertness or enhance physical performance.

Who shouldn’t take it?

Pseudoephedrine isn’t suitable for everyone. Although medicines containing it are now available over the counter, you will only be able to buy them after a consultation with a New Zealand-registered pharmacist.

If you have high blood pressure, diabetes, an overactive thyroid gland, glaucoma, or heart disease, you might be better off without it.

Pseudoephedrine is also more likely to cause side effects in infants, especially newborns and premature infants, than in older children or adults.

Codral, Sudafed and Nurofen cold and flu pills all contain pseudoephedrine - a key ingredient in the manufacture of the illegal drug P. Photo / Martin Sykes

Does it help with Covid-19 symptoms?

Pseudoephedrine can help alleviate milder symptoms of Covid-19, like congestion or a runny nose. But other overlapping symptoms like body aches or sore throats are better treated with over-the-counter pain relievers like ibuprofen or acetaminophen.

What else should you do when you have a winter lurgy?

All the usual advice your grandma gives you actually checks out.

Get plenty of rest to help your body recover, prioritise nutrition to boost your immune system, and stay hydrated - water, juice, herbal tea and broth all help to prevent dehydration, which can worsen symptoms.

Te Whatu Ora says to take fever reducers (like paracetamol or ibuprofen) and use honey or lozenges to sooth a sore throat and keep monitoring your symptoms.

When taking your meds, Healthify suggests you follow the directions on labelling carefully, as different cold and flu medicines have different doses, depending on the product. Capsules, tablets, liquid and powder meds aren’t always taken the same way. The packaging will tell you how much to take, how often to take it, and any special instructions.

Another pro-tip is to use a humidifier in your room - this will ease respiratory symptoms.

- RNZ