Pseudoephedrine: Uses, Dosage, and Side Effects Explained

Summary of Key Points

Pseudoephedrine is a nasal decongestant commonly used to relieve congestion caused by colds, allergies, or sinus infections. It works by narrowing the blood vessels in the nasal passages, which helps reduce swelling and congestion. Pseudoephedrine is available in various forms, including tablets and liquids. It is important to consult your healthcare provider before using this over-the-counter medication, especially if you have any underlying health conditions.

Names of Medication

Sudafed (Pseudoephedrine)

Zephrex-D (Pseudoephedrine)

The generic name, pseudoephedrine, is the active ingredient in these medications. Generic names are consistent across all brands and are often more affordable than brand-name versions.

Pharmacologic Category

Decongestants

Sympathomimetics

Pseudoephedrine Dosage

Pseudoephedrine is used to treat several conditions related to nasal and sinus congestion. Below are the recommended doses for adults. Always consult your doctor before adjusting your dose or starting a new medication. You can also schedule a telemedicine visit with one of our providers for personalized advice.

1. Allergic Rhinitis: 60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.
2. Sinusitis: 60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.
3. Nasal Congestion: 30-60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.
4. Common Cold: 30-60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.
5. Hay Fever: 60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.
6. Sinus Headache: 30-60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.
7. Eustachian Tube Dysfunction: 60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.
8. Otitis Media (Middle Ear Infection): 60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.
9. Upper Respiratory Infections: 30-60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.
10. Rhinitis: 60 mg every 4 to 6 hours as needed, not to exceed 240 mg per day.

Dosage Forms and Strengths

Pseudoephedrine is available in the following forms and strengths:

1. Tablets: 30 mg, 60 mg, 120 mg (extended-release), 240 mg (extended-release)
2. Liquid: 15 mg/5 mL

Administration Instructions

Pseudoephedrine can be taken with or without food. If you are using the extended-release form, swallow the tablet whole—do not crush, chew, or break it. Drink a full glass of water with each dose to help the medication work effectively. If you miss a dose, take it as soon as you remember, but avoid doubling up on doses. Always follow the instructions provided by your healthcare provider or pharmacist.

Pseudoephedrine Side Effects and Adverse Reactions

Like all medications, pseudoephedrine can cause side effects. Most are mild, but some can be more serious. If you experience any severe reactions, contact your healthcare provider immediately or schedule a telemedicine visit with one of our providers.

Common Side Effects (Occurring in 1-10% of patients):

1. Insomnia: Difficulty falling or staying asleep.
2. Nervousness: Feeling jittery or anxious.
3. Dizziness: Feeling lightheaded or unsteady.
4. Headache: Mild to moderate headaches.

Less Common Side Effects (Occurring in less than 1% of patients):

1. Increased Heart Rate: A faster than normal heartbeat.
2. High Blood Pressure: An increase in blood pressure, especially in people with pre-existing hypertension.
3. Dry Mouth: A feeling of dryness in the mouth.

Rare but Serious Side Effects:

1. Severe Allergic Reactions: Rash, itching, swelling, or difficulty breathing. Seek immediate medical attention if these occur.
2. Chest Pain: Pain or tightness in the chest, which may indicate a heart issue.
3. Severe Dizziness or Fainting: This could be a sign of a serious reaction and requires immediate medical attention.

Contraindications for Pseudoephedrine

A contraindication is a specific situation or condition where a medication should not be used because it may cause harm. For pseudoephedrine, there are several conditions where it is not recommended due to potential risks.

1. Severe Hypertension (High Blood Pressure): Pseudoephedrine can raise blood pressure, so it is not recommended for individuals with uncontrolled high blood pressure.
2. Severe Coronary Artery Disease: This condition affects the heart’s blood vessels, and pseudoephedrine may increase the risk of heart attack or other heart-related complications.
3. Glaucoma: Pseudoephedrine can increase pressure in the eyes, which may worsen glaucoma, especially in patients with narrow-angle glaucoma.
4. Hyperthyroidism: This condition causes an overactive thyroid, and pseudoephedrine may worsen symptoms such as increased heart rate and nervousness.
5. Urinary Retention: Pseudoephedrine can make it harder to urinate, especially in men with an enlarged prostate (benign prostatic hyperplasia).
6. Use of Monoamine Oxidase Inhibitors (MAOIs): Pseudoephedrine should not be taken if you are currently using or have recently used an MAOI (within the last 14 days), as this can lead to dangerous increases in blood pressure.

Drug to Drug Interactions

Some medications can interact with pseudoephedrine, potentially increasing side effects or reducing the effectiveness of your treatment. It’s important to inform your healthcare provider about all the medications you are currently taking. Below are some common drug interactions to be aware of:

Monoamine Oxidase Inhibitors (MAOIs): Medications such as phenelzine (Nardil) and tranylcypromine (Parnate) can cause a dangerous rise in blood pressure when combined with pseudoephedrine.

Beta-blockers: Drugs like propranolol (Inderal) or metoprolol (Lopressor) may become less effective when taken with pseudoephedrine, as pseudoephedrine can counteract their blood pressure-lowering effects.

Antidepressants: Certain antidepressants, such as amitriptyline (Elavil) or nortriptyline (Pamelor), may increase the risk of side effects like elevated heart rate or blood pressure when used alongside pseudoephedrine.

Stimulants: Medications like amphetamine (Adderall) or methylphenidate (Ritalin) can heighten the risk of side effects such as nervousness, increased heart rate, and high blood pressure when taken with pseudoephedrine.

Pseudoephedrine in Pregnancy

Is it Safe to Take Pseudoephedrine When Pregnant?

It is generally recommended to avoid pseudoephedrine during the first trimester, as some studies suggest a possible link to birth defects, such as gastroschisis (a condition where the baby’s intestines develop outside the body). However, pseudoephedrine may be considered during the second and third trimesters if the benefits outweigh the risks. Always consult your healthcare provider before taking any medication during pregnancy. If you are pregnant and experiencing nasal congestion, our telemedicine providers can help you find safer alternatives.

Pseudoephedrine While Breastfeeding

Is it Safe to Take Pseudoephedrine While Breastfeeding?

Pseudoephedrine passes into breast milk in small amounts and may reduce milk supply. It can also cause irritability in some breastfed infants. If you are breastfeeding, it’s important to discuss the risks and benefits with your healthcare provider before using pseudoephedrine. Our telemedicine providers can help you find the best treatment options while breastfeeding.

Estimated Cost of Pseudoephedrine

The cost of a 30-day supply of pseudoephedrine without insurance can vary depending on the pharmacy and location. Using a GoodRx coupon, the estimated cost for a 30-day supply of pseudoephedrine (30 mg tablets, taken every 4-6 hours) ranges from $5 to $15. Prices may fluctuate, so it’s a good idea to check with your local pharmacy or use a coupon service like GoodRx to find the best price.

Possible Alternatives to Pseudoephedrine

If you cannot take pseudoephedrine or are looking for other treatment options, several alternatives are available. Be sure to discuss these with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers can help you explore these options and find the best solution for your symptoms.

1. Allergic Rhinitis: Antihistamines like loratadine (Claritin) or cetirizine (Zyrtec) may help relieve allergy symptoms. Nasal corticosteroids such as fluticasone (Flonase) can also be effective.
2. Sinusitis: Saline nasal sprays or rinses can help clear mucus. In some cases, antibiotics may be prescribed if a bacterial infection is suspected.
3. Nasal Congestion: Nasal saline sprays or nasal corticosteroids like mometasone (Nasonex) can help reduce inflammation and congestion.
4. Common Cold: Rest, hydration, and over-the-counter medications like acetaminophen (Tylenol) for pain and fever can help manage symptoms.
5. Hay Fever: Antihistamines and nasal corticosteroids are commonly used to manage hay fever symptoms.
6. Sinus Headache: Pain relievers such as ibuprofen (Advil) or acetaminophen (Tylenol) can help with headache pain. Decongestants like oxymetazoline (Afrin) nasal spray may also provide relief.
7. Eustachian Tube Dysfunction: Nasal corticosteroids or antihistamines may help reduce inflammation and improve drainage.
8. Otitis Media (Middle Ear Infection): In some cases, antibiotics may be necessary. Pain relievers like acetaminophen or ibuprofen can help with discomfort.
9. Upper Respiratory Infections: Rest, fluids, and over-the-counter medications for symptom relief are typically recommended. Antibiotics are not effective for viral infections.
10. Rhinitis: Antihistamines, nasal corticosteroids, or nasal saline sprays can help manage symptoms of rhinitis.

Recent Updates on Pseudoephedrine Research

Recent studies have focused on the safety and effectiveness of pseudoephedrine, particularly in special populations such as pregnant women and individuals with cardiovascular conditions. Some research has explored the potential for pseudoephedrine to raise blood pressure in patients with pre-existing hypertension, leading to recommendations for more cautious use in these individuals. Additionally, ongoing research is examining the development of new decongestants that may offer similar benefits with fewer cardiovascular risks.

Staying informed about the latest research is important, especially if you have underlying health conditions. Our telemedicine providers are available to discuss the most up-to-date information and help you make informed decisions about your treatment.

James Kingsley

Learn More