Pseudoephedrine Hero or murderer presented by Kloyjai Kanjanarai

Pseudoephedrine Hero or murderer ? presented by Kloyjai Kanjanarai M. D. Sirirat Rattanaarpa M. D. supervised by Pramote Euasobhon M. D.

2 million tablets of pseudoephedrine @ Suvarnabhumi airport

Hot news Thai FDA has categorized PSEUDOEPHEDRINE as ‘controlled substance. ’

Hot news The Thai government told DSI to find suppliers of pseudoephedrine. Suppliers of pseudoephedrine, which the authority believes have been working at hospitals, would receive maximum punishments if found guilty. March 26, 2012 by Thai Financial Post

Hot news Health Ministry steps up control over pseudoephedrine production sales �The Public Health Ministry has stepped up its move to tackle the illicit use of pseudoephedrine in the country. April 5, 2012 by Thai Financial Post

Pseudoephedrine

Any difference? Ephredine Pseudoephredine Stereoisomer

Any difference? H OH Pseudoephedrine

Pseudoephedrine • Synthesis – Plant: Ephedra spp. – Commercial: Yeast + Dextrose

Pseudoephedrine • Mechanism of action – Sympathomimetic amine – May have weak or no 'direct' agonist activity at α- and β-adrenergic receptors • Vasoconstriction • Hypertension

Pseudoephedrine • Clinical use – Indication: • • Nasal/sinus congestion Sinusitis Allergic rhinitis Tracheobronchitis

What are the off-label uses of pseudoephedrine? 1. 2. 3. 4. Appetite suppressant Concentration aid Brain stimulant All of the above

Off-label uses of pseudoephedrine • Priaprism. • Ear infection. • Urinary incontinence.

Pseudoephedrine • Rules & regulation – Australia : : • 2006 - "Pharmacist Only Medicines" or "Prescription Only Medicines” -United kingdom : : • 2008 – “Law” Available over the counter under the supervision of a qualified pharmacist, or on prescription

Pseudoephedrine • Rules & regulation – U. S. A : : • Many requirement

Ephedrine • Mechanism of action – Sympathomimetic amine – β > α -adrenergic receptors

Ephedrine • Clinical uses – Decongestant – Hypotension-related to anesthesia • Off-label uses – Appetite suppressant – Concentration aid

Ephedrine • Rules & regulation – UK: Pharmacist/Prescription medicine – USA: Same as pseudoephedrine

How to make Amphetamine • How many tablets of pseudoephedrine (30 mg) are required to produce one tablet of amphetamine? 1. 1/3 2. 1 3. 3 4. 6

How to make Amphetamine 6 tablets of pseudoephedrine 1 tablet of amphetamine

Drug comparison Drug Alpha Beta 1 Beta 2 MAP Airway CNS Ephedrine ++ + + ++ -- yes Amphetamine ++ + NC* yes *NC = not change

Are there any required documents for prescribing pseudoephedrine in Siriraj hospital? 1. None 2. Doctor prescription 3. Doctor prescription + medical document for psychotropic substance )ย. ว. 2( 4. Doctor prescription + medical document for narcotics )ย. ส. 5(

Are there any required documents for prescribing pseudoephedrine in Siriraj hospital? • Doctor prescription + medical document for psychotropic substance )ย. ว. 2) are required. • ≤ 30 tablets

Are there any required documents for prescribing ephedrine in Siriraj hospital? 1. None 2. Doctor prescription 3. Doctor prescription + medical document for psychotropic substance )ย. ว. 2( 4. Doctor prescription + medical document for nacrotics )ย. ส. 5(

Imprison Nasal congestion Take pseudoephedrine

If you have pseudoephedrine, these documents are required. • Doctor’s document • Patient’s name • Hospital’s name

Would you still take pseudoephedrine if you have nasal congestion ? 1. Yes 2. No

Alternatives • Phenylephrine: – Pure alpha-adrenergic antagonist – Less decongestant activity – Half-life of 2. 5 hours – Dose: 10 mg every four hours

Differences? Receptor Half life Dose Phenylephrine Pseudoephedrine alpha beta & alpha 2. 5 hours 9 -16 hours 10 mg q 4 hours 60 mg q 6 hours

Drug comparison Drug Alpha Beta 1 Beta 2 MAP Airway CNS Ephedrine ++ + + ++ -- yes Amphetamine ++ + NC* yes 0 0 +++ NC* no Phenylephrine +++ *NC = not change

Take home messages • Pseudoephedrine – Psychotropic substance category 2 – Doctor prescription + medical document for psychotropic substance • Phenylephrine – Less decongestant – Short duration – No brain stimulation

Thank you Any comments or discussion