Many of us over the years have evolved to diving drug junkies. We begin our dive day with a mixture of coffee, aspirin and Sudafed. In recent months several accidents and near misses have produced concern as to the effects of Sudafed and other decongestants on divers, especially while deep diving and/or gas diving. However the same concerns have also been observed on more shallow air dives.

1. The opening point of concern occurred early this summer. An EANx cave diver died on a dive well within P02 limits. This was within commonly exceeded air P02 dives. It was noted that the divers blood gases contained a high level of pseudoephedrine, a major ingredient in Sudafed and associated generics. We vaguely questioned if this may have contributed to, or even caused the accident.
2. A diver using air died while cave diving in Missouri recently. Per his companions he called the dive, then bolted! He had taken Sudafed prior to the dive. On one other occasion he had exhibited the same behavior and survived. Before that particular dive he had once again used Sudafed.
3. Early this summer a diver accustomed to diving to 160 feet (48 meters) went almost comatose on a dive. His two companions had to maintain his regulator and assist him to shallower water. The only thing he had done different than normal was to take Sudafed prior to the dive.
4. A Trimix diver on a dive with a reasonable END felt he was losing it. The diver called the dive and made a controlled ascent. Again the only thing different than "normal" was the use of Sudafed preceding the dive.
5. A few years ago Patti Mount took a 12-hour Sudafed prior to diving and felt really "out of it" once at depth. This included feelings of apprehension and fighting to maintain consciousness. That was her last 12 hour Sudafed taken prior to diving. Patti had similar sensations on a dive, which she made after taking a Benadryl antihistamine tablet for a reaction to a jellyfish sting.
6. In the seventies while on a saturation dive on Hydrolab, one of my dive partners developed a cold. The dive medic gave the diver Actifed and he went into a coma for two days finally coming out of it once we were well into decompression.
7. Early this year after taking a Sudafed prior to a deep dive I experienced what I attributed at the time to narcosis, however it was the most severe narcosis I have ever had at a much shallower dive than I routinely make. Since I was on a light Trimix mixture and not air l can only attribute this to the Sudafed.
8. From Australia, Rob Cason reports Oceaneering International commercial dive company banned Sudafed over ten years ago due to its adverse effects on their divers.
9. Recent recreational occurrences in Australia as reported by Rob Cason IANTD Australasia, parallel those referenced above. In fact Sudafed warnings have likewise been issued there.

The above incidences are not conclusive as to the adverse effects of Sudafed and/or other decongestants while diving. They do represent grounds for concern and further investigation.

Gary Taylor, IANTD EANx IT#13 sent us a copy of the 1991 PDR description of pseudoephedrine hydrochloride, Sudafed's active ingredient. It states:

ADVERSE REACTIONS include nausea, cardiac palpitations, irritability, excitement, headache, dizziness, tachycardia, diarrhea, drowsiness, stomach pain, SEIZURES, slowed heart rate, shortness of breath, and/or troubled breathing; with an overdose add anxiety, tenseness, and respiratory difficulty.

TREATMENT: Includes the statement, "If convulsions or marked CNS excitement occurs Diazepam may be used."

Certainly this is food for thought. Personally Tom just gave up a ten-year habit of Sudafed diving. If you or anyone you know has had adverse reactions following a Sudafed or other "decongestant used" dive please forward this information to us. We will pass it on to responsible research / physiologist / physician personnel who are investigating this. If there seems to be a trend we will inform you of such in this journal. Thank you.

IANTD WISHES TO THANK BOTH INSTRUCTOR TRAINERS MARK LEONARD AND GARY TAYLOR FOR CARING ENOUGH TO TAKE THE TIME TO SHARE THE INFORMATION, WHICH LED TO THE RESEARCH OF THIS ARTICLE. WE ALL WANT TO MAKE DIVING SAFER. TOM