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I've noticed when I have a cold that taking pseudoephedrine (Sudafed) makes me a little wired. Don't have a cold now but the other night, working on four hours of sleep and going into another night time ED shift, I decided to take a 12-hour extended release pseudoephedrine tablet. It was great! Not only was I awake and feeling more enthusiastic than usual, I didn't need to eat or pee for almost my whole shift (definitely an advantage when you're running from patient to patient). So my question obviously is: is it dangerous to take a little pseudoephedrine once in awhile for this reason? If I were to do it during my surgery rotation or during residency when I'm on call, say once or twice a week, would I be running the risk of addiction or other problems? Anybody else tried this?
 

Kalel

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Your description of what happens to you makes pseudoephedrine sound like it's acting like a very potent sympathomimetic in you.It iis possible to become psychologically addicted to anything, but I've never heard of physical dependence being associated with pseudoephedrine. I'd just be careful in not taking too high of dosage at any time, and checking your blood pressure while you take it. Some people do take it on an every day basis (it's combined with some of the anti-histamine regimens as a way to treat allergies), so I don't think that it would be too bad if you took it every day. I'd reccomend that you try something like coffee first though.
 
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Sharkfan

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FYI, pseudoephedrine is considered a stimulant by USADA and WADA and has been banned from elite-level athletic competitions, so it obviously must provide some benefits in the alertness/quickness categories. I think the ban MIGHT have been lifted, but don't hold me to it; I'm not in the testing pool anymore and have stopped paying attention to things like that.

:D
 

carrigallen

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someone told me it basically it works the same way as caffeine...it will keep you up all night if take too many pills. I know first hand...one time I took like 6 pills over a six hour period for congestion, and I literally did not sleep a blink that night.
 

Yosh

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I too as an undergrad, with a bad sinus infection/congestion inadvertantly took too much pseudoephedrine...and ended up with heart arrythmia...and was rushed to the infirmary and university hospital.

Be careful...as it has similar effects to other "stimualnts"..and when not used properly...can have detramental effects..

Try getting fresh air, going to the gym...getting a drink...making a phone call...etc...
 

GiJoe

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So would a dose of benadryl help me focus on a 5 hour progress exam at school or mabey even the USMLE??
 

aphistis

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Originally posted by GiJoe
So would a dose of benadryl help me focus on a 5 hour progress exam at school or mabey even the USMLE??
Benadryl by itself is diphenhydramine. You can get it with psuedoephedrine, but I'd read the label before buying anything. Benadryl conks me out, good as gold, 15 minutes after I take it; not something I imagine you'd want happening on an overnight shift. ;)
 

KittenKnows

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It is my understanding that pseudoephedrine has a lot of similar chemical properties that ephedra has. So if this is the case, be careful how much pseudoephedrine (sudafed) you are taking. Personally, I never saw anything wrong with ephedra as long as it is taken as indicated. I have used it many times when I need a pick-me-up and the effects really are similar to pseudoephedrine.
 

zambezi

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As for the benadryl...if you are wanting to stay up at night, I wouldn't take that. I use it to sleep, usually as tylenol pm. It is on our standing orders for sleep at the hospital that I work in. Fabulous.
 

edmadison

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Originally posted by zambezi
As for the benadryl...if you are wanting to stay up at night, I wouldn't take that. I use it to sleep, usually as tylenol pm. It is on our standing orders for sleep at the hospital that I work in. Fabulous.

Why not just take generic diphenhydramine? What's the point in taking the tylenol instead of killing liver cells?

Ed
 

GO_MEDPEDS

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1. Using any drug in order to stay awake is just a bad idea. Even people who chronically use caffeine are asking for it... arrhythmias, dependence-induced headaches, and decreased performance when not drinking their several cups of coffee. If you need to use something to keep you awake, just stick to good old caffeine and try and limit the number of times you drink that extra cup (pot) of coffee.

2. I had a 29 year old woman patient suffer from a stroke secondary to Ephedra (MetaboLife)... it is not a benign drug, though pseudoephedrine is generally safer.

3. Unless you're the 5% of the population that actually gets paradoxically stimulated from antihistamines/diphenhydramine, then I wouldn't rely on Benaryl to keep you up. Taking some Benadryl or Tylenol Cold every once in awhile to sleep shouldn't be a problem (even a stiff drink may be helpful).

4. I seriously doubt that anyone is going to get serious liver damage from taking a few Tylenol Cold, even every day... with the number of patients I've seen in the ER on Vicodin, Extra-Strength Tylenol, and who wash it all down with a 6-pack, your liver will look pretty damn good.

5. As an aside, people can actually develop dependence on sympathomimetics... ICU patients can develop "dopamine addictions," where they will become reliant on pressors to keep their blood pressure from bottoming out. This will persist even after their cause for hypotension (shock, etc.) has been stabilized. Although I doubt this would occur with pseudoephedrine and the like, I do think you would start getting headaches if you stopped using it (just like caffeine).

:)
 

DocWagner

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I can openly admit that prior to medical school, and following a body building contest that I participated in...I took ephedrine daily for over a year, even 2 times a day.

While NOT chemically the same as pseudoephedrine, the sympathomimetic qualities produced a psychological dependence similar to needing your "daily" coffee or your Buzz before the workout (as any former meat head can relate).
Pure ephedrine known as "white crosses" at the time, is no longer legally available, and I suggest those those to NOT rely on sympathomimetics to maintain a level of alertness. The "rebound" fatigue is profound and well established.

For those entering into your third year of clinicals or even residency, I urge you to avoid anything stronger than coffee.

Often times, people using sympathomimetics for overnight shifts then turn to OTC antihistimines (ie benadryl) for the sedating effects for "sleepy time" following the shift.
While necessary at times, the routine use is dangerous and not advised.

Just trying to keep you healthy, from a current resident...to you.
 

double elle

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When doing an overnighter, I take a Provigil around 10-11 pm (200 mg) and that works pretty good - but I do start to get drowsy around 5 am.

Provigil is indicated for narcolepsy and they are investigating it's usage with shift workers and with truck drivers (I got that info off their website). The psychiatrist I was rotating with gave me about 25 samples of it for those days I couldn't stay awake. It works wonderfully! I even got to prescribe it to a patient who had chronic fatigue syndrome when I was on my FP rotation.

Do a search for Provigil and see if it could help. I only take it when I do overnight call...which is about 1 time per month...or if my daughter keeps me up all night and I need it the next day. It's very expensive (around 4 bucks/pill) and most docs won't give it out as samples - mostly because the office staff wants it! haha. You can take 1-2 pills, but I have never taken 2. It isn't a central nervous stimulant, so you don't get the jitters from it.

Anyway - if you are interested - you can look it up on the website and see if you can find a doc that can give you samples or a prescription. PS - I have no stock in the company or anything..I just found it to be really helpful on those desperately tired nights.
 

zambezi

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Originally posted by edmadison
Why not just take generic diphenhydramine? What's the point in taking the tylenol instead of killing liver cells?

Ed

I have that too, I switch between them, sometimes after a long shift of standing the tylenol helps with the aches (at age 25, I don't think that I should be aching yet...) . Thankfully, I don't take it too often (well, I try not to anyway). I can see how people can get used to taking a pill to help them sleep, because insomnia with shift work sucks. You start thinking that you need to take the pill to sleep, so you take it. You don't want to not take it because what if you can't sleep--then you are screwed for you night shift...At least I have no problem staying awake at work. The docs that I work with, as I mentioned before, often use the generic diphenhydramine for the sleep aid...not the tylenol pm.
 
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