Pseudoephedrine: Uses, Side Effects & Dosage Guide

There are two different salts of pseudoephedrine present in the market as OTC preparation. Either in a fixed-dose combination or as a single ingredient (more commonly) with the addition of one or more than one active ingredient such as NSAIDs (ibuprofen or aspirin), acetaminophen (paracetamol), dextromethorphan, guaifenesin, and antihistamines.

Pseudoephedrine is a powerful stimulant, but it is well known for constricting swollen nasal mucous membranes. It is often used as a nasal decongestant. Pseudoephedrine lessens the nasal congestion, edema, and tissue hyperemia commonly associated with allergies or colds. Pseudoephedrine increases the drainage of sinus secretions and also to open the obstructed eustachian tube. Pseudoephedrine can cause hypertension due to its vasoconstriction property, and hence it is a known side effect of Pseudoephedrine.

Pseudoephedrine can also be used for the treatment of recurrent priapism. Erection is mostly a parasympathetic response, so Pseudoephedrine’s sympathetic action may relieve recurrent priapism.  Pseudoephedrine can also be used to treat urinary incontinence, but this is not a recommended use of this drug.

Concomitant use of MAO (monoamine oxidase) inhibitors can lead to a hypertensive crisis.

Pseudoephedrine may alleviate the antihypertensive effects of veratrum alkaloids, mecamylamine, methyldopa, and reserpine. Beta-adrenergic antagonists may also interact with sympathomimetics. When Pseudoephedrine is used with digitalis, then it will increase the ectopic pacemaker activity. Kaolin decreases the rate of absorption of Pseudoephedrine, while antacids like omeprazole raise it.

Pseudoephedrine is an amine having sympathomimetic activity. The Pseudoephedrine directly acts on the adrenergic receptors, and this is a principal mechanism of Pseudoephedrine. It is believed that the vasoconstriction produced by Pseudoephedrine is an alpha-adrenergic response. 

Pseudoephedrine’s action on α achieves Pseudoephedrine’s vasoconstriction effect- and β2-adrenergic receptors to cause vasoconstriction and smooth muscle relaxation of the bronchi, respectively. The muscles lining the walls of blood vessels contain the Adrenergic alpha receptors—the muscles contract by stimulating the alpha-adrenergic receptors causing vasoconstriction. As a result of vasoconstriction of blood vessels Blood, fluid is not allowed to leave blood vessels to enter the sinus, throat, and nose lining resulting in less nasal membrane inflammation and, hence, ultimately causing less production mucus. Pseudoephedrine causes to alleviate the nasal congestion symptoms by promoting blood vessels’ vasoconstriction, especially in the nasal cavity.  Activation of β2-adrenergic receptors produces relaxation of the bronchioles’ smooth muscles and helps alleviate the congestion by dilatation or relaxation of bronchial smooth muscles.

If you take the over-the-counter drug for self-treatment, you should properly read all the guidelines mentioned on the label before consuming any OTC drug. Consult your doctor in case of any confusion, and if your doctor prescribed the Pseudoephedrine, take It as directed by your physician.

Take this medication orally as recommended by your physician or directed on the package. Pseudoephedrine is usually taken every 12 or 24 hours, depending on the severity of the congestion or as directed by your physician. Keep in mind that you should not exceed the daily recommended dose, which is 240mg. Consult your doctor if symptoms are not improving. 

If you are taking the Pseudoephedrine in the suspension form, shake well before use.  To get an exact recommended dose, you should use the measuring spoons and avoid using non-measuring spoons because of the risk of not taking the recommended dosage. 

Pseudoephedrine is available in various forms and brands in the market. Hence, it is wise to carefully read all the instructions because different brands may have different directions based on different doses. Avoid consuming more Pseudoephedrine as recommended.

Pseudoephedrine has some drug interactions; therefore, it is wise to consult your doctor if you are using some other drug with Pseudoephedrine. Caffeine interacts with Pseudoephedrine by enhancing the adverse effects of Pseudoephedrine. Therefore you should not use caffeine with Pseudoephedrine and avoid using such products containing caffeine. 

Consult with your doctor if any adverse reactions occur or if the symptoms for which you are taking medicine are not improving.

Many people use Pseudoephedrine as a stimulant because of its property to increase awareness or alertness. Because of this property, Pseudoephedrine is used by many athletes and truck drivers.

A study has also found that Pseudoephedrine can reduce milk production in breastfeeding women.

Pseudoephedrine can be found naturally in various plants as an alkaloid. Most of the Pseudoephedrine is produced by the fermentation of dextrose (yeast fermentation). This reaction is done in the presence of benzaldehyde.

Pseudoephedrine is produced commercially in China, mostly. In various countries, Pseudoephedrine is available with a prescription only due to its increase off label used by many peoples such as athletes and truck drivers.

Pseudoephedrine is not recommended in those patients who are already suffering from chronic diseases like diabetes mellitus. Still, the Pseudoephedrine’s effectiveness and safety as a nasal decongestant in children are not apparent.

Indications

Pseudoephedrine is used for

  • Stuffy nose
  • Sinus pain/pressure
  • Common cold
  • Flu
  • Breathing illnesses
  • Hay fever
  • Allergies
  • Bronchitis
  • As a decongestant (sympathomimetic).
  • Decreasing swelling and congestion.

Contraindications

Pseudoephedrine(PSE) should no be used or contraindicated in patients with

  • Diabetes mellitus
  • Cardiovascular disease
  • Uncontrolled or severe hypertension
  • Severe coronary artery disease
  • Prostatic hypertrophy
  • Hyperthyroidism
  • Closed angle glaucoma
  • Pregnant women
  • The use and safety of pseudoephedrine and its effectiveness in children, as a nasal decongestant, is unclear.

Side Effects

  • Nausea
  • Vomiting
  • trouble sleeping
  • Dizziness
  • Headache
  • Nervousness
  • Insomnia
  • Anxiety
  • Tachycardia
  • Palpitations
  • Mydriasis (rare)

Warnings

Discontinue taking pseudoephedrine if any of these rarely signs and symptoms start appearing or consult immediately with your doctor:

  • Irregular and fast heartbeat
  • Mood changes
  • Anxiety
  • Confusion
  • Restlessness
  • Tremor  
  • Abdominal pain
  • Difficulty urinating.

High Risk Groups

  • Pregnant mothers
  • Known case of cardiovascular disease patients
  • Patients on antihypertensive therapy
  • Patients with Renal and liver insufficiency
  • Patients with previous history of allergic reactions