There are three nasal decongestants that are used in OTC cough formulas in
the USA: PPA, pseudoephedrine, and phenyleprine (the latter is almost
always found with antihistamines). PPA is also known as phenylpropanolamine
(from which the acronym PPA is derived), norephedrine, and the IUPAC name
[alpha-(1-aminoethyl)benzyl alcohol]. Pseudoephedrine, known as the brand
name SudafedTM, has the IUPAC name [(+)alpha-(1-methylamino)benzyl
alcohol]. Phenyleprine is [(-)-3-hydroxy-alpha-(methylaminomethyl)benzyl
alcohol] (1-2).

These decongestants belong to a class of chemicals known as the
phenethylamines; this class also includes methamphetamine, MDMA (ecstasy),
MDA, etc., and tend to be DEA scheduled. Decongestants are not scheduled by
the DEA (this is USA laws) because they do not have significant
psychostimulant activity. Ephedrine, which is similar to pseudoephedrine,
and is (or was, depending on your state) available throughout truck stops
and mail-order pharmaceutical companies in the USA, does have mild
stimulant properties; thus its popularity as a form of “legal speed”. All
of these drugs stimulate the sympathetic nervous system (the “fight or
flight” system) and are thus called sympathomimetics.

What nasal decongestants do share with the more potent amphetamines is the
peripheral activity common to sympathomimetics, such as vasoconstriction
(constriction of blood vessels) and decreased nasal secretions (the good
side), and - with larger doses - insomnia, hypertension, heart rhythm
abnormalities, hemorrhaging, stroke, or death (the bad side) (8). Note that
these are extreme reactions, and that individual tolerance to
sympathomimetics tends to vary considerably. Tolerance can build quickly,
and a fatal dose for one person may have only a mild effect on another

Because of the potential danger of hypertension, exceeding the recommended
dose of DXM and decongestant containing preparations may be asking for
trouble. Most people can probably handle it in smaller recreational doses,
but the peripheral “speediness” can be distinctly unpleasant. Anyone with
high blood pressure or the like has no business taking large quantities of

Finally, more recent research suggests that many of DXM’s potentially
disturbing side effects (see Section 6) might be potentiated by any
stimulant. Panic attacks, hyperthermia, hypertensive crisis, and the like
are notable examples. In extreme cases, stroke or brain hemorrhage may be

Conclusion: Possibly suitable for first plateau use only; otherwise avoid
these drugs!

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