Pseudoephedrine and the heart?

[bluebanded goby]

Recently a dive boat captain mentioned to me that he knew an older diver who had used Sudafed (pseudoephedrine) so much and for so long that it "screwed up his heartbeat," and he was compelled to have a pacemaker installed.

Is this plausible? I'm wondering if maybe the fellow had just gotten to the age where some kind of heart irregularity manifested. Are there other cases where long-term use of a stimulant like pseudoephedrine has done this? Thanks for any info.

 

[ssra30]

I don't think there is any report of direct damage to the heart by pseudoephedrine. However it can raise blood pressure significantly so for chronic use, it certainly put a person at risk for a heart attack. Depending on the location of the heart attack, it certainly can cause problem with conduction pathway and pacemaker may be required. However, since heart attack is relatively common, there is no way to say that chronic pseudoephedrine usage was solely responsible.

 

[scubadoc]

Hello BBG:

It's doubtful that pseudoehphdrine caused the need for a pace maker - more likely some other factor as you have suggested. As a matter of fact, Sudafed was studied in divers and found to be safe [no mention of arrhythmias] but caused an increase in heart rate. Depth caused a decrease in the rate, counteracting the effects of the sudafed.

A search of Medline failed to bring up any studies or reports showing that Sudafed caused arrhythmias or the need for a pacemaker.

Here is a warning 'blurb' about Sudafed;
" Do not take Sudafed tablets if: You are allergic to any of the ingredients You have high blood pressure or heart disease You are taking or have taken. drugs for depression including monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants in the last two weeks.

Take special care with Sudafed tablets if:
You have diabetes, an over-active thyroid. glaucoma (pressure in the eye) or prostate problems You have liver or kidney disorders You are taking other medicines including Appetite suppressants, other decongestants and stimulants
Medicines to treat high blood pressure (e.g. methyldopa)."

There are quite a few threads on this board that deal with sudafed. A good one containing some links from DocVikingo is at http://www.scubaboard.com/showthread.php?s=&threadid=27164&highlight=sudafed

 

[daytona]

It's approved by the FAA for airline pilots. How bad can it be?

OTOH, I wouldn't be taking it every day.

Eric

 

[mdr231]

Pseudoephedrine does a great job for me in allowing me to equalize easilly since I'm often congested due to allergies. However, it also makes me VERY hyper and anxious, even when taking relatively low doses. I also notice higher heart rate while taking. I get the sense from speaking to people about it that reactions can vary a great deal from person to person. In my case, the speed-effect is not pleasant and I try to avoid it when at all possible.

Michael

 

[Rick Murchison]

Sudafed will cause heart arrhythmia in me with 100% certainty. A single dose will cause the arrhythmia within several hours and it will last off & on for up to two days. Every time. Obviously I don't take it - it took the docs a while to associate my allergy with sudafed - (along with just about any other over-the-counter decongestant except oxymetazoline (Afrin)).
As a matter of interest, heartbeat irregularities (tachycardia and palpitations) are the first listed side-effects of Sudafed.
So if you experience a wierd heartbeat a few hours after taking Sudafed, Actifed, or anything like those, you aren't alone.
Rick

 

[ssra30]

Rick Murchison once bubbled...
Sudafed will cause heart arrhythmia in me with 100% certainty. A single dose will cause the arrhythmia within several hours and it will last off & on for up to two days. Every time. Obviously I don't take it - it took the docs a while to associate my allergy with sudafed - (along with just about any other over-the-counter decongestant except oxymetazoline (Afrin)).
As a matter of interest, heartbeat irregularities (tachycardia and palpitations) are the first listed side-effects of Sudafed.
So if you experience a wierd heartbeat a few hours after taking Sudafed, Actifed, or anything like those, you aren't alone.
Rick

Yes, pseudoephedrine can cause your heart to go fast (tachycardia) or palpitation (heart racing feeling) but it is still in sinus rhythm ,meaning that it is fast but with normal conduction.
Generally this is less troublesome, can be caused by many different things and often relatively easily reversible. However when we talk about arrythmia that requires pacemaker as in this case, it is very different. It implies that there are blockages somewhere in the conductoin pathway of the heart or failure to generate regular electrical rhythm by the heart. In this sort of situation, I don't think pseudoephedrine has ever been reported as a culprit.

 

[Rick Murchison]

Yes, pseudoephedrine can cause your heart to go fast (tachycardia) or palpitation (heart racing feeling) but it is still in sinus rhythm ,meaning that it is fast but with normal conduction.

In my case the Sudafed causes PVC - which, I believe, qualifies as arrhythmia, does it not?
It's very annoying and (mentally) uncomfortable, though not painful. I don't suspect it's "good" for me, and in someone with any kind of heart disease I suspect it could be the "straw that broke the camel's back."
I avoid Sudafed and all other oral decongestants, and that keeps it from happening.
----------------------
I also do not suspect that either tachycardia or palpitations are good for you even if they are "in sinus rhythm" and I question the wisdom of using Sudafed when diving if anyone ever experiences either one of these too. Indeed, I'm really against using any drug that has epinephrine-like effects when diving Nitrox - I believe that when studies are finally conducted it will be found that there is a synergistic effect between oral decongestants like Sudafed and OxTox. There is already anecdotal evidence that there have been OxTox hits at well below the normally safe level of Oxygen exposure in divers taking Sudafed. Inconclusive at this time, but my experience with the drug, and others who note heightened "nervousness" with it are, to me, a clear contraindication, especially when diving Nitrox.
Rick

 

[ssra30]

Yes PVC is certainly not normal, especially when it is more than a few per minutes. Still kind of rare though for pseudoephedrine to do it but strictly speaking, being a symphatomemitic drug ie stimulating the sympathetic nervous system (epinephrine or adrenaline etc), I suppose it can make your heart excitable enough that you can get the ventricle to contract without stimulation from upstream.
Thanks for sharing this information. This is not one of the frequent side effect but certainly should be considered.
The good news is that even with frequent PVCs, you still won't need a pacemaker

I agree with you completely about avoiding as much drug as possible since most drugs will have some side effect, some worse than other and many people will have various degree and types of reactions. I am not trying to defend pseudoephedrine as a perfectly safe drug and it should only be used sparingly when neccessary. However, I don't think that it is the cause for the guy initially discussed, for the need for pacemaker.

 

[Rick Murchison]

ssra30 once bubbled...
However, I don't think that it is the cause for the guy initially discussed, for the need for pacemaker.

Nor do I. Indeed, there's a pretty good chance the Sudafed saved this guy's life by getting him an EKG that revealed the need for a pacemaker that may have otherwise gone unnoticed until too late.
Rick