NutriStack
Cocaine and Pseudoephedrine, contraindicated.
Pseudoephedrine and cocaine are both sympathomimetic stimulants, so combined use can sharply increase blood pressure, heart rate, vasoconstriction, and myocardial oxygen demand. Cocaine is linked to acute hypertension, coronary spasm, arrhythmias, myocardial infarction, and sudden cardiovascular events. Adding pseudoephedrine can further intensify adrenergic stress.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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At a glance
- Substances
- Cocaine and Pseudoephedrine
- Pair type
- Contraindicated
- Evidence (highest tier)
- Moderate
- Source citations
- 3 sources
- Stack Score effect
- −25 to your Stack Score (per scored contraindication row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Contraindicated · Moderate evidence
Contraindicated
What is happening. Pseudoephedrine and cocaine are both sympathomimetic stimulants, so combined use can sharply increase blood pressure, heart rate, vasoconstriction, and myocardial oxygen demand. Cocaine is linked to acute hypertension, coronary spasm, arrhythmias, myocardial infarction, and sudden cardiovascular events. Adding pseudoephedrine can further intensify adrenergic stress.
Mechanism. Pseudoephedrine indirectly increases synaptic norepinephrine and activates alpha and beta adrenergic pathways. Cocaine blocks norepinephrine, dopamine, and serotonin reuptake and also causes vasoconstriction and sodium-channel effects, making the cardiovascular load additive and potentially unstable.
Recommendation. Do not use pseudoephedrine if you have used cocaine or may use cocaine soon. Seek urgent care for chest pain, severe headache, fainting, severe agitation, or a very fast or irregular heartbeat. Use non-stimulant congestion treatments instead.
Sources (3)
- Salerno SM, Jackson JL, Berbano EP. Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis. Arch Intern Med. 2005;165(15):1686-1694. PMID 16087815
- Kim ST, Park T. Acute and Chronic Effects of Cocaine on Cardiovascular Health. Int J Mol Sci. 2019;20(3):584. PMID 30700023
- Schindler CW. Cocaine and cardiovascular toxicity. Addict Biol. 1996;1(1):31-47. PMID 12893485
Stack Score
How this pair moves the number.
Effect on the composite score
If both Cocaine and Pseudoephedrine are in the same stack, this pair applies −25 to your Stack Score (per scored contraindication row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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