pseudoephedrine

(soo dow e fed' rin)

pseudoephedrine hydrochloride (d-isoephedrine

hydrochloride)
Cenafed, Decofed, Efidac/24, Eltor (CAN), Sudafed, Sudodrin, Triaminic
Allergy Congestion, and others

pseudoephedrine sulfate
Drixoral Non-Drowsy Formula

Pregnancy Category C

Drug classes
Nasal decongestant
Sympathomimetic amine

Therapeutic actions
Effects are mediated by alpha-adrenergic receptors; causes vasoconstriction in mucous
membranes of nasal passages, resulting in their shrinkage, which promotes drainage and
improves ventilation.

Indications
• Temporary relief of nasal congestion caused by the common cold, hay fever, other
respiratory allergies
• Nasal congestion associated with sinusitis
• Promotes nasal or sinus drainage
• Relief of eustachian tube congestion

Contraindications and cautions

• Contraindicated with MAOI therapy, allergy or idiosyncrasy to sympathomimetic
amines, severe hypertension and coronary artery disease.
• Use cautiously with hyperthyroidism, diabetes mellitus, arteriosclerosis, ischemic
heart disease, increased IOP, prostatic hypertrophy, lactation, pregnancy.

Available forms
Tablets—30, 60 mg; CR tablets—240 mg; ER tablets—120 mg; chewable tablets—
15 mg; capsules—30, 60 mg; liquid—15, 30 mg/5 mL; drops—7.5 mg/0.8 mL

Dosages
ADULTS
60 mg q 4–6 hr PO (sustained-release, 120 mg PO q 12 hr; 240 mg/day CR); do not
exceed 240 mg in 24 hr.
PEDIATRIC PATIENTS
• 3–12 mo: 3 drops/kg q 4–6 hr PO, up to 4 doses per day.
 • 1–2 yr: 7 drops (0.02 mL/kg) q 4–6 hr PO; up to 4 doses per day.
• 2–5 yr: 15 mg as syrup q 4–6 hr PO; do not exceed 60 mg in 24 hr.
• 6–12 yr: 30 mg q 4–6 hr PO; do not exceed 120 mg in 24 hr.
GERIATRIC PATIENTS
These patients are more likely to experience adverse reactions; use with caution.

Pharmacokinetics
Route Onset Duration
Oral 30 min 4–6 hr

Metabolism: Hepatic; T1/2: 7 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Fear, anxiety, tenseness, restlessness, headache, light-headedness,
dizziness, drowsiness, tremors, insomnia, hallucinations, psychological
disturbances, prolonged psychosis, seizures, CNS depression, weakness, blurred
vision, ocular irritation, tearing, photophobia, orofacial dystonia
• CV: Hypertension, arrhythmias, CV collapse with hypotension, palpitations,
tachycardia, precordial pain
• Dermatologic: Pallor, sweating
• GI: Nausea, vomiting, anorexia
• GU: Dysuria, urinary retention in BPH
• Respiratory: Respiratory difficulty

Interactions
Drug-drug
• Increased hypertension with MAOIs, guanethidine, furazoladine
• Increased duration of action with urinary alkalinizers (potassium citrate, sodium
citrate, sodium lactate, tromethamine, sodium acetate, sodium bicarbonate)
• Decreased therapeutic effects and increased elimination of pseudoephedrine with
urinary acidifiers (ammonium chloride, sodium acid phosphate, potassium
phosphate)
• Decreased antihypertensive effects of methyldopa

Nursing considerations
Assessment
• History: Allergy or idiosyncrasy to sympathomimetic amines, severe
hypertension and CAD, hyperthyroidism, diabetes mellitus, arteriosclerosis,
increased IOP, prostatic hypertrophy, pregnancy, lactation
• Physical: Skin color, T; reflexes, affect, orientation, peripheral sensation, vision;
BP, P, auscultation; R, adventitious sounds; urinary output, bladder percussion,
prostate palpation

Interventions
 • Administer cautiously to patients with CV disease, diabetes mellitus,
hyperthyroidism, increased IOP, hypertension, and to patients > 60 yr who may
have increased sensitivity to sympathomimetic amines.
• Avoid prolonged use; underlying medical problems may be causing the
congestion.
• Monitor CV effect carefully; hypertensive patients who take this drug may
experience changes in BP because of the additional vasoconstriction. However, if
a nasal decongestant is needed, pseudoephedrine is the drug of choice.

Teaching points
• Do not exceed the recommended daily dose; serious overdose can occur. Use
caution when using more than one over-the-counter preparation because many of
these drugs contain pseudoephedrine, and unintentional overdose may occur.
• Avoid prolonged use because underlying medical problems can be disguised.
• These side effects may occur: Dizziness, weakness, restlessness, light-headedness,
tremors (avoid driving or performing hazardous tasks).
• Report palpitations, nervousness, sleeplessness, sweating.

Adverse effects in Italic are most common; those in Bold are life-threatening.