Pseudoephedrine

1. Introduction

Pseudoephedrine is a decongestant used to relieve nasal congestion associated with colds, allergies, sinusitis, and hay fever. It works by constricting blood vessels in the nasal passages, reducing swelling and congestion. Pseudoephedrine is often included in combination medications with antihistamines, analgesics, or other ingredients for managing cold and flu symptoms.

2. Indications

  • Relief of nasal and sinus congestion due to:
    • Common cold
    • Allergic rhinitis (hay fever)
    • Sinusitis
  • Eustachian tube congestion associated with ear infections or air travel.

3. Dosage

Adults and Children (≥12 years):

  • Immediate-release tablets: 60 mg every 4–6 hours as needed (maximum: 240 mg/day).
  • Extended-release tablets: 120 mg every 12 hours or 240 mg once daily.

Children (6–11 years):

  • Immediate-release tablets: 30 mg every 4–6 hours as needed (maximum: 120 mg/day).

Children (<6 years):

  • Not recommended for use in children under 6 years due to safety concerns.

Elderly:

  • Start with the lowest effective dose and monitor closely for cardiovascular side effects.

4. Administration

  • Take orally with or without food.
  • Swallow extended-release tablets whole; do not crush, chew, or break them.
  • Avoid taking close to bedtime to minimise the risk of insomnia.

5. Forms Available

  • Immediate-release tablets: 30 mg, 60 mg
  • Extended-release tablets: 120 mg, 240 mg
  • Oral solution: 15 mg/5 mL, 30 mg/5 mL

6. Side Effects

6.1 Common Side Effects:

  • Nervousness
  • Insomnia
  • Dizziness
  • Increased heart rate (tachycardia)

6.2 Less Common Side Effects:

  • Headache
  • Restlessness
  • Dry mouth

6.3 Rare but Serious Side Effects:

  • Hypertension (elevated blood pressure)
  • Palpitations or arrhythmias
  • Severe allergic reactions (e.g., rash, swelling, or difficulty breathing)

7. Warnings

  • Hypertension and Heart Disease: Pseudoephedrine may worsen high blood pressure or heart conditions. Use cautiously in patients with cardiovascular disease.
  • Urinary Retention: Increased risk in patients with prostatic hypertrophy or other urinary tract obstruction.
  • CNS Stimulation: May cause nervousness, restlessness, or insomnia, particularly at higher doses.

8. Precautions

  • Avoid prolonged use (more than 7 days) without medical advice.
  • Use cautiously in patients with diabetes, hyperthyroidism, or glaucoma.
  • Avoid combining with other decongestants or stimulants to reduce the risk of side effects.

9. Interactions

  • Monoamine oxidase inhibitors (MAOIs): Contraindicated due to the risk of severe hypertensive crisis.
  • Beta-blockers: May reduce the antihypertensive effects of beta-blockers.
  • Caffeine: Increases the risk of CNS stimulation (e.g., nervousness or insomnia).
  • Antidepressants (e.g., tricyclics): Enhanced cardiovascular effects.

10. Monitoring Parameters

  • Blood pressure and heart rate in patients with cardiovascular risk factors.
  • Monitor for signs of nervousness, restlessness, or insomnia.
  • Observe for any allergic reactions, especially during initial doses.

11. Use in Children

  • Use is not recommended in children under 6 years due to potential side effects, including nervous system and cardiovascular risks.
  • Doses for children aged 6–11 should be carefully calculated and monitored.

12. Use in Pregnancy

  • Category C: Use only if the potential benefit outweighs the risk to the foetus. Pseudoephedrine is not recommended in the first trimester due to a potential risk of gastroschisis or other foetal abnormalities.

13. Use in Elderly

  • Use with caution in elderly patients, particularly those with cardiovascular conditions, as they may be more sensitive to side effects like hypertension and tachycardia.

14. Use in Kidney Disease

  • Dose adjustment may be required in patients with renal impairment, as pseudoephedrine is primarily excreted by the kidneys.

15. Use in Liver Disease

  • No specific dose adjustments are required, but monitor closely in severe hepatic impairment.

16. Patient Counselling Points

  • Do not exceed the recommended dose, as this may increase the risk of side effects.
  • Avoid taking pseudoephedrine close to bedtime, as it may cause insomnia.
  • Inform your doctor if you have high blood pressure, heart disease, or any other medical conditions before use.
  • Avoid combining with other cold or flu medications that contain pseudoephedrine or similar decongestants.
  • If symptoms persist for more than 7 days or worsen, seek medical advice.

17. Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
SudafedJohnson & Johnson30 mg Tablet$10 (24 tablets)
NexafedAcura Pharmaceuticals30 mg Tablet$12 (24 tablets)
Generic PseudoephedrineVarious30 mg Tablet$5 (24 tablets)

18. 15 FAQs (Frequently Asked Questions)

1. What is Pseudoephedrine used for?
Pseudoephedrine is used to relieve nasal and sinus congestion caused by colds, allergies, and sinusitis.

2. How does Pseudoephedrine work?
It constricts blood vessels in the nasal passages, reducing swelling and congestion.

3. Can Pseudoephedrine cause insomnia?
Yes, insomnia is a common side effect due to its stimulant properties.

4. Is Pseudoephedrine safe for children?
It is not recommended for children under 6 years due to safety concerns.

5. Can Pseudoephedrine raise blood pressure?
Yes, it may raise blood pressure, especially in patients with pre-existing hypertension.

6. Can I take Pseudoephedrine with other cold medications?
Avoid combining with other medications containing pseudoephedrine or similar decongestants to prevent overdose.

7. Can Pseudoephedrine cause nervousness?
Yes, nervousness and restlessness are common side effects.

8. Is Pseudoephedrine addictive?
Pseudoephedrine is not addictive, but its stimulant effects can be misused.

9. Can I use Pseudoephedrine during pregnancy?
It should be avoided during the first trimester unless deemed necessary by a doctor.

10. How should I store Pseudoephedrine?
Store at room temperature, away from moisture and heat.

11. How long can I use Pseudoephedrine?
Do not use it for more than 7 days without consulting a doctor.

12. Can Pseudoephedrine cause rapid heart rate?
Yes, tachycardia is a possible side effect, particularly at higher doses.

13. Does Pseudoephedrine interact with antidepressants?
Yes, it may interact with MAOIs and tricyclic antidepressants, increasing cardiovascular risks.

14. Can I take Pseudoephedrine with caffeine?
Avoid excessive caffeine intake, as it may increase nervousness or restlessness.

15. Is Pseudoephedrine available over-the-counter?
Yes, but it is often regulated due to its potential use in the illicit production of methamphetamine.