Sudafed prior to diving--is it safe?

[Centrals]

Pseudoephedrine.
It is illegal in some countries, eg. Philippines, so be warned if you are going to bring some of them for your overseas diving trips.

How to Make Sure You Travel With Medication Legally (Published 2018)

Traveling with medication — even prescription drugs — isn’t as simple as packing it. Here’s how to stay on the right side of the law, anywhere you go.

www.nytimes.com

 

[drrich2]

I don’t know about Sudafed

I've seen 'regular,' 12-hour and 24-hour forms for sale. I will say this...in my anecdotal personal experience, even the 24-hour form doesn't seem as effective late afternoon/evening on multiple dive days as it was in the morning. I think it does help, and I'm a fan, but I still have to pay attention to my ears.

 

[drrich2]

Pseudoephedrine.
It is illegal in some countries, eg. Philippines

Thanks, I didn't know that about the Philippines. It's also true of Cozumel (though some people sneak it in, there is a risk of running afoul of the authorities).

 

[Duke Dive Medicine]

A systematic review in 2019 did not find any strong evidence of ill effects from pseudoephedrine under hyperbaric conditions: Systematic review on the effects of medication under hyperbaric conditions: consequences for the diver - PubMed

An animal study in 2013 found that high doses of pseudoephedrine can reduce hyperoxic seizure latency in rats. Note that the animals were dived to 5 ATA on pure O2, and the doses that were found to reduce seizure latency were 100-320 mg per kg of body weight. The recommended dose of pseudoephedrine in adults is 60 mg every 4-6 hours, not to exceed 240 mg in 24 hours.

An old article by the late Dr. Ed Thalmann explains some of the lore:

http://www.danap.org/DAN_diving_safety/DAN_Doc/pdfs/Pseudoephedrine%20and%20diving.pdf

A 2000 study on the psychometric effects of pseudoephedrine on divers:

The psychometric and cardiac effects of pseudoephedrine in the hyperbaric environment - PubMed

Pseudoephedrine does not cause significant alterations in psychometric performance at 3 atm of pressure that might increase the risk of diving. Depth causes significant adverse effects on anxiety levels and semantic memory at 3 atm. Pseudoephedrine and depth have significant but opposite effects...

pubmed.ncbi.nlm.nih.gov

Best regards,
DDM

 

[gwklein]

DAN training guidance provides the following:

Summary​

Guidelines 4-6​

4. Decongestants, such as Sudafed, are not routinely recommended for divers.

• In selected divers, with minor difficulties in equalizing, decongestants may reduce the risk of damage to the ear and are therefore not unreasonable to use.
• However, as with all medication, there is the risk of side effects, and no medication should be tried for the first time underwater.
• Decongestants should never be used in an attempt to dive with a head cold or when the diver is otherwise unable to clear.
• Decongestants should only be prescribed by a medical professional and used for no more than five days continuously.

 

[jadairiii]

I avoid any OTC medication and take so little that Sudafed (and those like it) make me dopey. That said, i have suffered from allergies all my life, damaged a sinus cavity in the 90's diving so I do need "something". That something has always been a 12 hour nose spray. I've used different kinds over the years, mainly now Nasacort spray. This was a recommendation from my ENT.

 

[Marie13]

double post

 

[Marie13]

DAN training guidance provides the following:

Summary​

Guidelines 4-6​

4. Decongestants, such as Sudafed, are not routinely recommended for divers.

• In selected divers, with minor difficulties in equalizing, decongestants may reduce the risk of damage to the ear and are therefore not unreasonable to use.
• However, as with all medication, there is the risk of side effects, and no medication should be tried for the first time underwater.
• Decongestants should never be used in an attempt to dive with a head cold or when the diver is otherwise unable to clear.
• Decongestants should only be prescribed by a medical professional and used for no more than five days continuously.

DAN can’t be bothered to address the issue of chronic allergies. I’ve emailed repeatedly and just get the “see your doctor” crap. Use for no more than five days continuously? What a bunch of crap.

 

[drrich2]

Use for no more than five days continuously? What a bunch of crap.

I suspect that recommendation comes from lumping decongestants broadly together. Some non-steroidal nasal sprays can lead to a rebound congestion effect after days of use; some oral agents (Sudafed, from what I understand) don't seem prone to do that. I'm not inclined to veer off into that now, and it's probably beyond the scope of this thread.

So there are decongestant products that ought not to be used on an ongoing basis, but that doesn't mean it's all of them.

 

[Tracy]

As with all things, It depends.
I fought constant ear issues for a decade. Sudafed was the only way I was able to dive.
My doctor changed some drugs around a few years ago and put me on a soft tissue relaxer for blood pressure. All of my ear issues went away.
Now for my personal fun diving, I don't need to take any sudafed prior to the trip.

Let your doc know what issues you are having, there could be something you are already taking that can be tailored to fix a different issue.