IV. Adverse Effects

  1. Headache
  2. Nausea, Vomiting
  3. Loss of appetite
  4. Cardiac effects
    1. Hypertension
    2. Dysrhythmias (Tachycardia)
  5. CNS stimulation
    1. Seizures
    2. Insomnia
    3. Psychosis
    4. Agitation
  6. Other effects
    1. Cerebral Hemorrhage
    2. Cerebrovascular Accident

V. Preparations: Systemic Decongestants

  1. Pseudoephedrine (Sudafed)
    1. Available as prescription and over-the-counter in U.S.
    2. U.S. pharmacies keep this behind counter due to Methamphetamine production-related use
    3. Combined with Antihistamines that are suffixed with "-D"
  2. Phenylephrine (Sudafed PE)
    1. Available in U.S. OTC products at 10 mg
    2. Combined with Antihistamines that are suffixed with "-PE"
      1. Likely add nothing to Antihistamine efficacy (see below)
    3. No more effective as Placebo for congestion at this dose systemically
      1. Poor absorption compared with systemic Pseudoephedrine
      2. In contrast, Intranasal Phenylephrine (Intranasal Neo-Synephrine) is effective
      3. Hatton (2007) Ann Pharmacother 41(3):381-90 [PubMed]
  3. Nexafed
    1. Pseudophedrine preparation that turns to thick gel when tablet is disolved
    2. Designed to curb diversion of pseudophedrine to Methamphetamine production
    3. Will require prescription in some U.S. states and quantity that can be sold is limited
    4. (2013) Prescr Lett 20(2): 9

VI. Preparation: Alternative agents (Topical)

  1. Nasal Saline
  2. Limited use of Topical Decongestant (3 days only)
    1. Oxymetazoline (Afrin)
      1. Never use in young children ("One Pill Can Kill")
    2. Intranasal Phenylephrine (Intranasal Neo-Synephrine)
      1. Effective Decongestant, unlike oral Phenylephrine
      2. Safe for short-term use, even in younger patients

VII. Dosing: Pseudoephedrine (Sudafed)

  1. Adults: 60 mg PO q6h
  2. Child (30 mg/5ml elixir) - NOT recommended
    1. Ages 6-12 years: 30 mg (5 ml) per dose
    2. Ages 2-5 years: 15 mg (2.5 ml) per dose

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Cost: Medications

pseudoephedrine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
PSEUDOEPHEDRINE 30 MG TABLET Generic OTC $0.05 each
PSEUDOEPHEDRINE ER 120 MG TAB Generic OTC $0.34 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