Effectiveness of Pseudoephedrine as Adjunctive Therapy for Neurogenic Shock After Acute Spinal Cord Injury: A Case Series

Abstract

These data suggest that pseudoephedrine is an effective adjunctive therapy in facilitating the discontinuation of intravenous vasopressors and/or atropine in patients with acute SCI with neurogenic shock, although patients will typically require long durations of therapy.

Catecholamine Vasopressor Support Sparing Strategies in Vasodilatory Shock

“…Pseudoephedrine is an oral stereoisomer of ephedrine that activates α‐1 receptors leading to vasoconstriction and increased SBP . To date, pseudoephedrine has yet to be studied in patients with septic shock receiving vasopressors; however, a case series in 38 patients with neurogenic shock secondary to spinal cord injury demonstrated potential benefit in weaning of vasopressor infusions with adjunctive pseudoephedrine . The daily maximum doses of pseudoephedrine used in the cohort ranged from 60–720 mg/day.…”

Methylene Blue, Midodrine, and Pseudoephedrine

“…Adaptation usually occurs during the first 14 days of the injury but can be problematic in some patients for several years. 53 Acute therapy typically involves fluid administration and vasopressors, although this is not practical in patients requiring long-term treatment. In a case series conducted by Wood et al, 53 oral PSE was evaluated in patients admitted to a trauma ICU with SCI and neurogenic shock.…”

“…53 Acute therapy typically involves fluid administration and vasopressors, although this is not practical in patients requiring long-term treatment. In a case series conducted by Wood et al, 53 oral PSE was evaluated in patients admitted to a trauma ICU with SCI and neurogenic shock. Data were collected beginning 7 days prior to the initiation of PSE through 7 days after drug discontinuation or until the patient was discharged with PSE.…”

“…Twenty patients were discharged from the hospital with PSE therapy. 53 This suggests that PSE is effective as adjunctive therapy to assist in the weaning of vasopressors in patients with hypotension due to neurogenic shock.…”

“…Pseudoephedrine is an attractive option because it can be a readily accessible oral medication depending on state laws and is inexpensive. 53 Currently, the case series by Wood et al 53 is the largest study assessing the use of oral PSE in patients with autonomic dysfunction ( Table 2). Although the results are positive, the typical duration of therapy with PSE is unknown, since therapy was continued for 356 CRITICAL CARE NURSING QUARTERLY/OCTOBER-DECEMBER 2015 several weeks in the majority of the study patients.…”