Editing Pseudoephedrine (section)

===Use in exercise and sports===
Pseudoephedrine has been used as a [[performance-enhancing drug]] in [[exercise]] and [[sports]] due to its sympathomimetic and stimulant effects.<ref name="TrinhKimRitsma2015">{{cite journal | vauthors = Trinh KV, Kim J, Ritsma A | title = Effect of pseudoephedrine in sport: a systematic review | journal = BMJ Open Sport Exerc Med | volume = 1 | issue = 1 | pages = e000066 | date = 2015 | pmid = 27900142 | pmc = 5117033 | doi = 10.1136/bmjsem-2015-000066 | url = }}</ref><ref name="GheorghievHosseiniMoran2018">{{cite journal | vauthors = Gheorghiev MD, Hosseini F, Moran J, Cooper CE | title = Effects of pseudoephedrine on parameters affecting exercise performance: a meta-analysis | journal = Sports Med Open | volume = 4 | issue = 1 | pages = 44 | date = October 2018 | pmid = 30291523 | pmc = 6173670 | doi = 10.1186/s40798-018-0159-7 | doi-access = free | url = }}</ref> Because of these effects, pseudoephedrine can increase [[heart rate]], elevate [[blood pressure]], improve [[mental energy]], and reduce [[fatigue (medical)|fatigue]], among other performance-enhancing effects.<ref name="TrinhKimRitsma2015" /><ref name="GheorghievHosseiniMoran2018" /><ref name="SalernoJackson2005" />

A 2015 [[systematic review]] found that pseudoephedrine lacked performance-enhancing effects at therapeutic doses (60–120{{nbsp}}mg) but significantly enhanced athletic performance at supratherapeutic doses (≥180{{nbsp}}mg).<ref name="TrinhKimRitsma2015" /> A subsequent 2018 [[meta-analysis]], which included seven additional studies, found that pseudoephedrine had a small positive effect on heart rate ({{Abbrlink|SMD|standardized mean difference}} = 0.43) but insignificant effects on time trials, perceived exertion ratings, blood [[glucose]] levels, and blood [[lactic acid|lactate]] levels.<ref name="GheorghievHosseiniMoran2018" /> However, subgroup analyses revealed that [[effect size]]s were larger for heart rate increases and quicker time trials in well-trained athletes and younger participants, for shorter exercise sessions with pseudoephedrine administered within 90{{nbsp}}minutes beforehand, and with higher doses of pseudoephedrine.<ref name="GheorghievHosseiniMoran2018" /> A [[dose–response relationship]] was established, with larger doses (>170{{nbsp}}mg) showing greater increases in heart rate and faster time trials than with smaller doses (≤170{{nbsp}}mg) ({{Abbr|SMD|standardized mean difference}} = 0.85 for heart rate and {{Abbr|SMD|standardized mean difference}} = -0.24 for time trials, respectively).<ref name="GheorghievHosseiniMoran2018" /> In any case, the meta-analysis concluded that the performance-enhancing effects of pseudoephedrine were marginal to small and likely to be lower in magnitude than with [[caffeine]].<ref name="GheorghievHosseiniMoran2018" /> It is relevant in this regard that caffeine is a permitted stimulant in competitive sports.<ref name="GheorghievHosseiniMoran2018" />

Pseudoephedrine was on the [[International Olympic Committee]]'s (IOC) banned substances list until 2004 when the [[World Anti-Doping Agency]] (WADA) list replaced the IOC list. Although WADA initially only ''monitored'' pseudoephedrine, it went back onto the "banned" list on 1 January 2010.<ref>{{cite web |url=http://www.wada-ama.org/en/News-Center/Articles/WADA-2010-Prohibited-List-Now-Published/ |title=WADA 2010 Prohibited List Now Published – World Anti-Doping Agency |publisher=Wada-ama.org |access-date=6 May 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120220000116/http://www.wada-ama.org/en/News-Center/Articles/WADA-2010-Prohibited-List-Now-Published/ |archive-date=20 February 2012 }}</ref>

Pseudoephedrine is excreted through urine, and the concentration in urine of this drug shows a large inter-individual spread; that is, the same dose can give a vast difference in urine concentration for different individuals.<ref>{{cite web|url=https://www.researchgate.net/publication/8957642|access-date=24 February 2014|title=Elimination of ephedrines in urine following multiple dosing the consequences for athletes in relation to doping control|archive-date=29 August 2021|archive-url=https://web.archive.org/web/20210829014432/https://www.researchgate.net/publication/8957642_Elimination_of_ephedrines_in_urine_following_multiple_dosing_The_consequences_for_athletes_in_relation_to_doping_control|url-status=live}}</ref> Pseudoephedrine is approved to be taken up to 240&nbsp;mg per day. In seven healthy male subjects, this dose yielded a urine concentration range of 62.8 to 294.4 microgram per milliliter (μg/mL) with mean ± standard deviation 149 ± 72&nbsp;μg/mL.<ref>{{cite journal | vauthors = Strano-Rossi S, Leone D, de la Torre X, Botrè F | title = The relevance of the urinary concentration of ephedrines in anti-doping analysis: determination of pseudoephedrine, cathine, and ephedrine after administration of over-the-counter medicaments | journal = Therapeutic Drug Monitoring | volume = 31 | issue = 4 | pages = 520–526 | date = August 2009 | pmid = 19571776 | doi = 10.1097/FTD.0b013e3181ac6006 | s2cid = 21333203 }}</ref> Thus, normal dosage of 240&nbsp;mg pseudoephedrine per day can result in urine concentration levels exceeding the limit of 150&nbsp;μg/mL set by WADA for about half of all users.<ref>{{cite web|url=http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/WADA_Additional_Info_Pseudoephedrine_2010_EN.pdf|title=Ressources|access-date=18 August 2016|archive-url=https://web.archive.org/web/20140529020420/http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/WADA_Additional_Info_Pseudoephedrine_2010_EN.pdf|archive-date=29 May 2014|url-status=dead}}</ref> Furthermore, hydration status does not affect the urinary concentration of pseudoephedrine.<ref>{{cite journal | vauthors = Jolley D, Dawson B, Maloney SK, White J, Goodman C, Peeling P | title = Hydration and urinary pseudoephedrine levels after a simulated team game | journal = International Journal of Sport Nutrition and Exercise Metabolism | volume = 24 | issue = 3 | pages = 325–332 | date = June 2014 | pmid = 24458099 | doi = 10.1123/ijsnem.2013-0076 | url = http://research-repository.uwa.edu.au/en/publications/hydration-and-urinary-pseudoephedrine-levels-after-a-simulated-team-game(f5215f21-7653-4fd6-85f6-61c790e0eba6).html }}</ref>

====List of doping cases====
* Canadian rower [[Silken Laumann]] was stripped of her [[1995 Pan American Games]] team gold medal after testing positive for pseudoephedrine.<ref>{{cite news|url=http://www.cbc.ca/archives/categories/sports/drugs-in-sports/going-for-dope-canada-and-drugs-in-sport/squeaky-clean-silken-tests-positive.html|title=Silken tests positive|access-date=24 February 2014|archive-date=4 March 2014|archive-url=https://web.archive.org/web/20140304160658/http://www.cbc.ca/archives/categories/sports/drugs-in-sports/going-for-dope-canada-and-drugs-in-sport/squeaky-clean-silken-tests-positive.html|url-status=live}}</ref>
* In February 2000, [[Elena Berezhnaya]] and [[Anton Sikharulidze]] won gold at the [[2000 European Figure Skating Championships]] but were stripped of their medals after Berezhnaya tested positive. This resulted in a three-month disqualification from the date of the test, and the medal being stripped.<ref name=wallech>{{cite book | url = https://books.google.com/books?id=6EThoEOnGuUC&pg=PA86 | title = Complete Book of the Winter Olympics | vauthors = Wallechinsky D | author-link = David Wallechinsky | year = 2009 | publisher = Greystone Books | access-date =9 July 2010 | isbn = 978-1-55365-502-2 }}</ref> She stated that she had taken cold medication approved by a doctor but had failed to inform the ISU as required.<ref name=disq>{{cite web | url = http://www.iceskatingintnl.com/archive/results_worlds/world00p.htm | title = 2000 World Championships – Pairs | publisher = Ice Skating International | access-date = 6 June 2010 | archive-date = 14 November 2011 | archive-url = https://web.archive.org/web/20111114140356/http://www.iceskatingintnl.com/archive/results_worlds/world00p.htm | url-status = dead }}</ref> The pair missed the World Championships that year as a result of the disqualification.
* Romanian gymnast [[Andreea Răducan]] was stripped of her gold medal at the [[2000 Summer Olympic Games]] after testing positive. She took two pills given to her by the team coach for a cold. Although she was stripped of the overall gold medal, she kept her other medals, and, unlike in most other doping cases, was not banned from competing again; only the team doctor was banned for a number of years. [[Ion Țiriac]], the president of the Romanian Olympic Committee, resigned over the scandal.<ref>{{cite web |url=https://assets.espn.go.com/oly/summer00/news/2000/0925/776388.html |title=Summer Olympics 2000 Raducan tests positive for stimulant |publisher=[[ESPN]] |date=26 September 2000 |access-date=6 May 2012 |archive-date=2 October 2011 |archive-url=https://web.archive.org/web/20111002111033/http://assets.espn.go.com/oly/summer00/news/2000/0925/776388.html |url-status=live }}</ref><ref>{{cite web|url=http://www.intlgymnast.com/news2000/oct3.html |archive-url=https://web.archive.org/web/20010715112418/http://www.intlgymnast.com/news2000/oct3.html |archive-date=15 July 2001 |title=Amanar Tops Romanian Money List |publisher=International Gymnast Magazine Online |date=15 October 2000 |access-date=6 May 2012}}</ref>
* In the [[2010 Winter Olympic Games]], the IOC issued a reprimand against the Slovak [[ice hockey]] player [[Lubomir Visnovsky]] for usage of pseudoephedrine.<ref>{{cite web |url=http://www.olympic.org/news/ioc-issues-a-reprimand-against-slovakian-ice-hockey-player-lubomir-visnovsky/77600 |title=IOC issues a reprimand against Slovakian ice hockey player |access-date=24 February 2014 |archive-date=8 March 2014 |archive-url=https://web.archive.org/web/20140308181150/http://www.olympic.org/news/ioc-issues-a-reprimand-against-slovakian-ice-hockey-player-lubomir-visnovsky/77600 |url-status=live }}</ref>
* In the [[2014 Winter Olympic Games]] [[Sweden men's national ice hockey team|Team Sweden]] and [[Washington Capitals]] ice hockey player [[Nicklas Bäckström]] was prevented from playing in the final for usage of pseudoephedrine. Bäckström claimed he was using it as allergy medication.<ref>{{cite web |url=https://www.tsn.ca/nhl/story/?id=444510 |title=Sweden's Bäckström tests positive for banned substance |access-date=24 February 2014 |archive-url=https://web.archive.org/web/20140227072846/http://www.tsn.ca/nhl/story/?id=444510 |archive-date=27 February 2014 |url-status=dead }}</ref> In March 2014, the IOC Disciplinary Commission decided that Bäckström would be awarded the silver medal.<ref name="IOC">{{cite web | url=http://www.olympic.org/news/ioc-decision-swedish-ice-hockey-player-nicklas-backstrom-to-receive-sochi-silver-medal/227378 | title=IOC Decision – Swedish ice hockey player Nicklas Backstrom to receive Sochi silver medal. | work=IOC | date=14 March 2014 | access-date=14 March 2014 | archive-date=15 March 2014 | archive-url=https://web.archive.org/web/20140315224712/http://www.olympic.org/news/ioc-decision-swedish-ice-hockey-player-nicklas-backstrom-to-receive-sochi-silver-medal/227378 | url-status=live }}</ref> In January 2015 Bäckström, the IOC, WADA and the [[International Ice Hockey Federation|IIHF]] agreed to a settlement in which he accepted a reprimand but was cleared of attempting to enhance his performance.<ref name="Washington Post">{{cite news | url=https://www.washingtonpost.com/blogs/capitals-insider/wp/2015/01/15/nicklas-backstroms-olympic-doping-appeal-resolved-with-reprimand/ | title=Nicklas Backstrom's Olympic doping appeal resolved with reprimand | newspaper=The Washington Post | date=15 January 2015 | access-date=18 January 2015 | vauthors=Prewitt A | archive-date=17 January 2015 | archive-url=https://web.archive.org/web/20150117170505/http://www.washingtonpost.com/blogs/capitals-insider/wp/2015/01/15/nicklas-backstroms-olympic-doping-appeal-resolved-with-reprimand/ | url-status=live }}</ref>