Effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock after acute spinal cord injury

A case series

G Christopher Wood, Andrew B. Boucher, Jessica L. Johnson, Jennifer N. Wisniewski, Louis J. Magnotti, Martin Croce, Joseph Swanson, Bradley Boucher, Timothy Fabian

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

STUDY OBJECTIVE To evaluate the effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock in patients with acute spinal cord injury (SCI). DESIGN Case series. SETTING Academic medical center. PATIENTS Thirty-eight patients admitted to the trauma intensive care unit between September 2005 and October 2012 with an acute SCI and who received more than 1 day of pseudoephedrine for one or more of the following: treatment of bradycardia (heart rate < 50 beats/min), treatment of hypotension (systolic blood pressure < 90 mm Hg), or were receiving intravenous vasopressor support. MEASUREMENTS AND MAIN RESULTS The effect of adjunctive pseudoephedrine (PSE) was categorized as a success if vasopressors were discontinued after the initiation of PSE or improvement in the number of episodes of bradycardia was noted after the initiation of PSE as evidenced by decreased use of atropine. The effect of pseudoephedrine was categorized as a failure if it did not meet one of the criteria for success. The effect of pseudoephedrine was categorized as inconclusive if there were confounding factors such as vasopressors being restarted for another indication after initial discontinuation. Pseudoephedrine was successful in 31/38 (82%) patients, failed in 2/38 (5%) patients, and had inconclusive results in 5/38 (13%) patients. The mean ± SD time to successful weaning of intravenous vasopressors was 7 ± 7 days. Daily maximum pseudoephedrine doses ranged from 60-720 mg. Mean ± SD duration of pseudoephedrine therapy was 32 ± 23 days (range 2-135 days), with 64.5% of surviving patients discharged while receiving pseudoephedrine. CONCLUSION 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.

Original languageEnglish (US)
Pages (from-to)89-93
Number of pages5
JournalPharmacotherapy
Volume34
Issue number1
DOIs
StatePublished - Jan 1 2014

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Pseudoephedrine
Convulsive Therapy
Spinal Cord Injuries
Bradycardia
Atropine
Blood Pressure
Therapeutics
Weaning
Hypotension
Intensive Care Units

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

Effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock after acute spinal cord injury : A case series. / Wood, G Christopher; Boucher, Andrew B.; Johnson, Jessica L.; Wisniewski, Jennifer N.; Magnotti, Louis J.; Croce, Martin; Swanson, Joseph; Boucher, Bradley; Fabian, Timothy.

In: Pharmacotherapy, Vol. 34, No. 1, 01.01.2014, p. 89-93.

Research output: Contribution to journalArticle

Wood, G Christopher ; Boucher, Andrew B. ; Johnson, Jessica L. ; Wisniewski, Jennifer N. ; Magnotti, Louis J. ; Croce, Martin ; Swanson, Joseph ; Boucher, Bradley ; Fabian, Timothy. / Effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock after acute spinal cord injury : A case series. In: Pharmacotherapy. 2014 ; Vol. 34, No. 1. pp. 89-93.
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abstract = "STUDY OBJECTIVE To evaluate the effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock in patients with acute spinal cord injury (SCI). DESIGN Case series. SETTING Academic medical center. PATIENTS Thirty-eight patients admitted to the trauma intensive care unit between September 2005 and October 2012 with an acute SCI and who received more than 1 day of pseudoephedrine for one or more of the following: treatment of bradycardia (heart rate < 50 beats/min), treatment of hypotension (systolic blood pressure < 90 mm Hg), or were receiving intravenous vasopressor support. MEASUREMENTS AND MAIN RESULTS The effect of adjunctive pseudoephedrine (PSE) was categorized as a success if vasopressors were discontinued after the initiation of PSE or improvement in the number of episodes of bradycardia was noted after the initiation of PSE as evidenced by decreased use of atropine. The effect of pseudoephedrine was categorized as a failure if it did not meet one of the criteria for success. The effect of pseudoephedrine was categorized as inconclusive if there were confounding factors such as vasopressors being restarted for another indication after initial discontinuation. Pseudoephedrine was successful in 31/38 (82{\%}) patients, failed in 2/38 (5{\%}) patients, and had inconclusive results in 5/38 (13{\%}) patients. The mean ± SD time to successful weaning of intravenous vasopressors was 7 ± 7 days. Daily maximum pseudoephedrine doses ranged from 60-720 mg. Mean ± SD duration of pseudoephedrine therapy was 32 ± 23 days (range 2-135 days), with 64.5{\%} of surviving patients discharged while receiving pseudoephedrine. CONCLUSION 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.",
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