NutriStack
MDMA and Pseudoephedrine, contraindicated.
Pseudoephedrine can add to MDMA's stimulant cardiovascular effects. Controlled human studies show MDMA increases blood pressure, heart rate, and thermogenic/cardiostimulant measures, while pseudoephedrine also raises blood pressure and pulse. The combination is especially concerning during dancing, heat exposure, dehydration, panic, or underlying heart disease.
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
- MDMA 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 can add to MDMA's stimulant cardiovascular effects. Controlled human studies show MDMA increases blood pressure, heart rate, and thermogenic/cardiostimulant measures, while pseudoephedrine also raises blood pressure and pulse. The combination is especially concerning during dancing, heat exposure, dehydration, panic, or underlying heart disease.
Mechanism. Pseudoephedrine increases adrenergic signaling through norepinephrine release and alpha/beta receptor stimulation. MDMA increases monoamine release, including norepinephrine, and produces sympathomimetic cardiovascular stimulation and thermogenic stress; together they can amplify rate-pressure product and heat strain.
Recommendation. Do not use pseudoephedrine if you have used MDMA or may use MDMA soon. Seek urgent help for chest pain, severe headache, overheating, fainting, confusion, or a racing or irregular heartbeat. Use non-stimulant nasal congestion options 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
- Hysek C, Schmid Y, Rickli A, et al. Carvedilol inhibits the cardiostimulant and thermogenic effects of MDMA in humans. Br J Pharmacol. 2012;166(8):2277-2288. PMID 22404145
- Kirkpatrick MG, Gunderson EW, Perez AY, Haney M, Foltin RW, Hart CL. A direct comparison of the behavioral and physiological effects of methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) in humans. Psychopharmacology (Berl). 2012;219(1):109-122. PMID 21713605
Stack Score
How this pair moves the number.
Effect on the composite score
If both MDMA 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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