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Pseudoephedrine

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 4 minutes read
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Pseudoephedrine is used to temporarily relieve symptoms of congestion caused by cold, flu and allergies. It works by reducing the blood flow in your nose and reduces swelling and discomfort allowing you to breathe more easily. It is one of the active ingredients in many over-the-counter cold and flu medications such as Sudafed, Sinutab, Actifed as well as many others. It can come in many different formulations such as capsules, liquids and tablets and can only be purchased from a pharmacy.

Doctor’s advice

Who is it for?

This medication can be used by patients over the age of 12, however some products with lower doses can be used in children over 6 years old under guidance from a pharmacist. It is used for relieving cold, flu and allergy symptoms associated with congested blocked noses.

How does it work?

Pseudoephedrine belongs to a class of medications known as sympathomimetic agents, which mimic the effects of the sympathetic nervous system. By activating alpha-adrenergic receptors, pseudoephedrine constricts blood vessels in the nasal mucosa, leading to a reduction in nasal congestion. This mechanism of action makes it a valuable treatment option for relieving symptoms of nasal congestion associated with upper respiratory tract infections, allergies, and sinusitis.

Pseudoephedrine is available in various formulations, including tablets, capsules, and oral solutions, often combined with other ingredients, such as antihistamines or analgesics, to provide comprehensive symptom relief. These products are typically labelled for short-term use to alleviate acute symptoms of nasal congestion, with recommended dosing regimens outlined on the packaging.

Should anyone avoid taking it?

Pseudoephedrine is not suitable for children below 6 years, and shouldn’t be taken alongside other decongestant medications. If you are pregnant or breastfeeding you should not use this medication unless directed by your doctor. You should speak to a pharmacist if you have a thyroid disorder, diabetes, heart disease or high blood pressure.

Are there any side-effects?

As with any medications, some people are bound to get some unwanted side effects. Some of the common ones include nausea, headaches, dry mouth, agitation, nervousness, insomnia. In some rare cases people can develop fast, uneven or pounding heartbeats (palpitations). If this happens you should stop taking the medication and seek medical advice.

Commonly asked questions about pseudoephedrine

Why is it only short term use?

While pseudoephedrine is generally considered safe and effective when used as directed for short-term relief of nasal congestion, certain precautions should be taken to minimise the risk of adverse effects and ensure optimal therapeutic outcomes. Patients should adhere to the recommended dosage and duration of treatment specified on the product label or as advised by a healthcare professional.

Short-term use of pseudoephedrine is generally well-tolerated in most individuals. However, certain populations may be at higher risk of experiencing adverse effects, including those with pre-existing cardiovascular conditions such as hypertension, coronary artery disease, or arrhythmias. In such cases, caution should be exercised when using pseudoephedrine, and consultation with a healthcare professional may be warranted before initiating treatment.

Furthermore, individuals with a history of drug abuse or dependence, particularly on sympathomimetic agents such as pseudoephedrine, should use caution when using this medication to avoid the risk of misuse or diversion. Healthcare providers should assess the potential for substance abuse and provide appropriate guidance and support to patients as needed.

What is rebound congestion?

One of the notable concerns associated with the use of pseudoephedrine is the phenomenon known as rebound congestion or rhinitis medicamentosa. Rebound congestion occurs when prolonged or excessive use of nasal decongestants, including pseudoephedrine, leads to a paradoxical worsening of nasal congestion upon discontinuation of the medication.

The exact mechanism underlying rebound congestion is not fully understood but is believed to involve changes in the responsiveness of nasal blood vessels to sympathetic stimulation following prolonged exposure to vasoconstrictive agents. As a result, individuals who rely on pseudoephedrine for long-term symptom relief may experience a rebound effect when attempting to discontinue the medication, leading to a cycle of persistent nasal congestion and the need for continued use of decongestants.

To mitigate the risk of rebound congestion, it is essential to adhere to the recommended duration of treatment with pseudoephedrine and avoid prolonged or excessive use of the medication. Healthcare providers should educate patients about the potential for rebound congestion and encourage the use of alternative treatment strategies, such as saline nasal sprays, steroid nasal sprays, or antihistamines, for long-term management of nasal congestion associated with chronic conditions such as allergic rhinitis or sinusitis.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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