Check the Pseudoephedrine Cold Medicine Warning in Pakistan: DRAP Alert 49
DRAP Safety Alert 49 says pseudoephedrine cold medicines must not be used with severe high blood pressure or kidney failure. See the warning signs to stop on.
Short answer: DRAP Safety Alert 49 says cold and allergy medicines with pseudoephedrine must not be used by people with severe or uncontrolled high blood pressure or severe kidney disease. Stop the medicine and get urgent medical help if you get a sudden, severe headache, vomiting, confusion, seizures or changes in vision.
Winter brings coughs, blocked noses and a drawer full of cold tablets. Many of those tablets contain pseudoephedrine, a decongestant. It clears the nose. For most people that is all it does.
For a few people it carries a rare but serious risk. The Drug Regulatory Authority of Pakistan (DRAP) warned about it in Safety Alert 49, dated 27 April 2024. We read the full alert on dra.gov.pk on 14 October 2026. This page puts it in plain words. It is not medical advice. Ask your doctor or pharmacist about your own medicines.
Pseudoephedrine can cause two rare brain blood vessel conditions
The alert says pseudoephedrine is linked to PRES and RCVS. These are rare conditions in which the blood supply to the brain is reduced. DRAP says they can be life-threatening. With quick diagnosis and treatment, the alert says, symptoms usually go away.
PRES stands for posterior reversible encephalopathy syndrome. RCVS stands for reversible cerebral vasoconstriction syndrome. You do not need to remember the names. You only need to know the warning signs.
DRAP says no fatal cases were reported internationally, and most cases improved after the medicine was stopped and treatment was given. The alert says the risk should be weighed with other risks of pseudoephedrine medicines, including heart and circulation events.
Know the warning signs that mean stop the medicine
The alert lists a sudden, severe headache, sometimes called a thunderclap headache, nausea, vomiting, confusion, seizures and changes in vision. If you have any of these after taking a pseudoephedrine medicine, stop it at once and get urgent medical help.
- Stop taking the medicine.
- Get urgent medical help. Do not wait to see if it passes.
- Take the box or strip with you.
- Tell the doctor the product name and how long you took it.
- Report the reaction to DRAP afterwards.
A normal cold headache builds slowly. The alert describes a sudden, severe headache. If you are not sure, treat it as a reason to call a doctor. For emergency numbers by province, see our page on Edhi and Chhipa ambulance numbers in Pakistan.
Two groups of people should not take pseudoephedrine
The alert says pseudoephedrine medicines must not be used by people with severe or uncontrolled high blood pressure, meaning untreated or resistant to treatment, or with severe acute or chronic kidney disease or kidney failure. These are listed as risk factors.
The table shows who the alert names and what it says. The alert is not a general ban for everyone.
| Who | What DRAP's alert says |
|---|---|
| Severe or uncontrolled high blood pressure | Do not use pseudoephedrine medicines |
| Severe acute or chronic kidney disease or failure | Do not use pseudoephedrine medicines |
| Anyone with a sudden severe headache, vomiting, confusion, seizures or vision changes | Stop and get urgent medical help |
| Doctors and pharmacists | Advise patients to stop and seek help if symptoms appear |
| Makers | Update the warning section of the label and issue a health professional letter |
Check the ingredient list on your cold medicine
Pseudoephedrine is an active ingredient, so it appears on the box under the name pseudoephedrine, often with a number like 30 mg or 60 mg. Brand names vary. DRAP's alert does not list brands, so check the ingredient line, not the brand.
Cold and flu products often combine several ingredients. Read the full list, not just the first line. If you are not sure, ask the pharmacist to read the ingredients with you. A DRAP check that a medicine is registered tells you if the product is legal. It does not tell you if it suits your health.
If you have high blood pressure or kidney disease, ask your doctor before you buy any cold remedy. Our page on who needs Tamiflu for flu explains which groups the National Institute of Health marks as high risk, and the flu vaccine page covers prevention.
What DRAP told makers to do
DRAP's expert committee met on 26 February 2024. It decided that holders of registrations must update the warning section of the label with these risks and issue a direct letter to health professionals. This means new labels should carry the warning over time.
We did not check individual product labels, so we cannot say which brands have been updated. If your box does not mention it, the alert still applies.
To report a reaction, use the Med Vigilance e-reporting form on the DRAP website or the Med Safety app. Our guide to how to report a medicine side effect to DRAP shows each step. The National Pharmacovigilance Centre phone is +92 51 9255981.
Common questions
Is pseudoephedrine banned in Pakistan?
No. Alert 49 does not ban it. It adds warnings and says who must not use it.
Can I take it with mild high blood pressure that is treated?
The alert names severe or uncontrolled high blood pressure. For treated or mild cases, ask your doctor. We cannot advise you.
What is a thunderclap headache?
It is the alert's term for a sudden, severe headache that reaches its worst within moments.
Does the alert apply to children?
The alert does not mention children or give age limits. Ask a doctor before giving any cold medicine to a child.
Which brands contain pseudoephedrine?
The alert names none. Check the ingredient list on the box for the word pseudoephedrine.
How do I report a bad reaction?
Use the DRAP Med Vigilance form or the Med Safety app, as the alert says.
How we verified this
What we checked, where we read it, and what we could not confirm.
Last checked on 14 October 2026, Pakistan time. We read DRAP Safety Alert 49 in full on dra.gov.pk. The alert is dated 27 April 2024 and the DRAP list shows it under May 2024. We did not check product labels. This page is not medical advice. Ask a doctor or pharmacist about your own medicines.
About the author
Public Services and Education Journalist
Fajr Riaz is a journalist and content writer at Pakistan Era, based in Lahore. She covers the questions people meet in everyday life in Pakistan: how a public service works, what a change in the rules means, and where to find a reliable answer.
