II. Indications
III. Contraindications
IV. Adverse Effects
- Headache
- Nausea, Vomiting
- Loss of appetite
- Cardiac effects
- CNS stimulation
- Other effects
- Cerebral Hemorrhage
- Cerebrovascular Accident
V. Medications: Systemic Decongestants
- Pseudoephedrine (Sudafed)
- Available as prescription and over-the-counter in U.S.
- U.S. pharmacies keep this behind counter due to Methamphetamine production-related use
- Combined with Antihistamines that are suffixed with "-D"
- Dosing
- Adults: 60 mg PO q6h
- Child (30 mg/5ml elixir) - NOT recommended
- Ages 6-12 years: 30 mg (5 ml) per dose
- Ages 2-5 years: 15 mg (2.5 ml) per dose
-
Phenylephrine (Sudafed PE)
- Available in U.S. OTC products at 10 mg
- Combined with Antihistamines that are suffixed with "-PE"
- Likely add nothing to Antihistamine efficacy (see below)
- No more effective than Placebo for congestion at this dose systemically
- FDA has as of 2023, labeled oral Phenylephrine as ineffective
- Poor absorption (low Bioavailability) compared with systemic Pseudoephedrine
- In contrast, Intranasal Phenylephrine (Intranasal Neo-Synephrine) is effective
- Hatton (2007) Ann Pharmacother 41(3):381-90 [PubMed]
- Nexafed
- Pseudophedrine preparation that turns to thick gel when tablet is disolved
- Designed to curb diversion of pseudophedrine to Methamphetamine production
- Will require prescription in some U.S. states and quantity that can be sold is limited
- (2013) Prescr Lett 20(2): 9
VI. Medications: Alternative agents (Topical)
- Nasal Saline
- Limited use of Topical Decongestant (3 days only)
- Oxymetazoline (Afrin)
- Never use in young children ("One Pill Can Kill")
- Intranasal Phenylephrine (Intranasal Neo-Synephrine)
- Effective Decongestant, unlike oral Phenylephrine
- Safe for short-term use, even in younger patients
- Oxymetazoline (Afrin)
Images: Related links to external sites (from Bing)
Related Studies
| pseudoephedrine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PSEUDOEPHEDRINE 30 MG TABLET | Generic OTC | $0.06 each |
| PSEUDOEPHEDRINE 60 MG TABLET | Generic OTC | $0.05 each |
| PSEUDOEPHEDRINE ER 120 MG TAB | Generic OTC | $0.28 each |
Ontology: Pseudoephedrine (C0033798)
| Definition (NCI) | A phenethylamine and a diastereomer of ephedrine with sympathomimetic property. Pseudoephedrine displaces norepinephrine from storage vesicles in presynaptic neurones, thereby releasing norepinephrine into the neuronal synapses where it stimulates primarily alpha-adrenergic receptors. It also has weak direct agonist activity at alpha- and beta- adrenergic receptors. Receptor stimulation results in vasoconstriction and decreases nasal and sinus congestion. |
| Definition (MSH) | A phenethylamine that is an isomer of EPHEDRINE which has less central nervous system effects and usage is mainly for respiratory tract decongestion. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D054199 |
| SnomedCT | 372900003, 91435002 |
| LNC | LP16130-4, MTHU017941 |
| English | (1S,2S)-2-methylamino-1-phenyl-propan-1-ol, Pseudoephedrine, PSEUDOEPHEDRINE, Pseudoephedrine [Chemical/Ingredient], pseudoephedrine, Pseudoephedrine (product), Pseudoephedrine (substance) |
| Portuguese | Pseudoefedrina |
| Spanish | Seudoefedrina, pseudoefedrina (sustancia), seudoefedrina (sustancia), Pseudoefedrina, pseudoefedrina (producto), pseudoefedrina, seudoefedrina |
| Finnish | Pseudoefedriini |
| French | Pseudoéphédrine |
| German | Pseudoephedrin |
| Italian | Pseudoefedrina |
| Russian | ИЗОЭФЕДРИН, ПСЕВДОЭФЕДРИН, PSEVDOEFEDRIN, IZOEFEDRIN |
| Swedish | Pseudoefedrin |
| Czech | pseudoefedrin |
| Polish | Pseudoefedryna, Izoefedryna |
| Japanese | イソエフェドリン, プソイドエフェドリン, 塩酸シュードエフェドリン, プソイドエフェドリン塩酸塩, シュードエフェドリン, D-プソイドエフェドリン, 塩酸プソイドエフェドリン, スダフェド, D-塩酸プソイドエフェドリン |
Ontology: Decongestants (C0282374)
| Concepts | Pharmacologic Substance (T121) |
| MSH | D014663 |
| SnomedCT | 96328007, 417901007 |
| LNC | LP31486-1 |
| Spanish | descongestivo, descongestivo (sustancia), Descongestionantes, preparado descongestivo (producto), preparado descongestivo (sustancia), preparado descongestivo |
| French | Médicaments décongestionnants, Agents décongestionnants, Décongestionnants |
| Portuguese | Descongestionantes |
| German | Dekongestionsmittel |
| English | decongestants (medication), decongestants, decongestant, Decongestant preparation (product), Decongestant preparation, Decongestants, Decongestant preparation, NOS, Decongestant, NOS, Decongestant preparation (substance), Decongestant, Decongestant (substance) |
| Czech | dekongestiva |
| Italian | Decongestionanti |
Ontology: Sudafed (C0700727)
| Definition (MSH) | Pseudoephedrine hydrochloride. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D054199 |
| English | Sudafed, sudafed |
| Czech | Sudafed |
