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pseudoephedrine (Sudafed, Afrin, Drixoral, SudoGest)

Tradename: Sudafed. Restricted substance* (see alternatives to pseudoephedrine) Indications: - temporary relief of nasal congestion - sinusitis [6] - allergic rhinitis, allergic conjunctivitis [6]* * avoid for treatment of allergic rhinitis [8] - risk of cardiovascular events cited Contraindications: use with caution in patients with: 1) renal failure 2) uncontrolled hypertension [3] 3) diabetes 4) ischemic heart disease 5) increased intraocular pressure 6) prostatic hypertrophy 7) urinary retention 8) thyroid disease Dosage: 1) 60 mg PO every 4-6 hours. 2) 30 mg/dose if 6-13 yo. 3) 15 mg/dose if 2-5 yo. Tabs: 30 & 60 mg. Elixir: 30 mg/5 mL. Timed-release: Afrin, Drixoral. 120 mg PO BID. Tabs: 120 mg. Infant drops: (PediaCare Infant's decongestant) 7 drops/kg PO every 4-6 hours up to 4 doses/day if > 1 yo. 3 drops/kg if 3-12 months. Pharmacokinetics: 1) onset of action is within 30 minutes when taken on an empty stomach 2) duration of action is 3 hours with immediate-release preparations & 8-12 hours with sustained-release preparations Adverse effects: 1) nervousness 2) insomnia 3) irritability 4) tachycardia: ave increase in heart rate 2.3 beats/min [4] 5) increase in systolic blood pressure 1 mm Hg [4] 6) urinary retention - may constrict smooth muscle of the bladder neck & prostatic urethra & exacerbate BPH (GRS9) [7] Drug interactions: 1) MAO inhibitors: severe headache, hypertension & hypertensive crisis 2) phenothiazines may antagonize effects of decongestants 3) tricyclic antidepressants may increase pressor effects 4) agents which acidify the urine increase urinary secretion 5) agents which alkalinize the urine decrease elimination & may result in toxic accumulation 6) decreased effect of terazosin & other alpha adrenergic agonists Laboratory: - pseudoephedrine in specimen - pseudoephedrine in gastric fluid - pseudoephedrine in serum/plasma - pseudoephedrine in urine - ephedrine+pseudoephedrine in stool - ephedrine+pseudoephedrine in meconium - ephedrine+pseudoephedrine in vitreous fluid Mechanism of action: 1) indirect-acting alpha & beta adrenergic receptor agonist 2) causes smooth muscle vasoconstriction, pressor effect & nasal decongestion * Because of the potential for chemical conversion to methamphetamine, pseudoephedrine & ephedrine are restricted substances. As of Sept 30, 2006, pseudoephedrine & ephedrine will be behind the counter. Only 3.6 g/day & 9 g/month will be dispensed. This works out to be 120 tablets of pseudoephedrine 30 mg per day, or 300 tabs/month. [5]

Related

alternatives to pseudoephedrine

General

decongestant

Properties

MISC-INFO: elimination route LIVER pregnancy-category C safety in lactation -

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Prescriber's Letter 10(10):60 2003
  4. Salerno SM, Jackson JL, Berbano EP. Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis. Arch Intern Med. 2005 Aug 8-22;165(15):1686-94. PMID: 16087815 - Coates ML, Rembold CM, Farr BM. Does pseudoephedrine increase blood pressure in patients with controlled hypertension? J Fam Pract. 1995 Jan;40(1):22-6. PMID: 7807033
  5. Prescriber's Letter 13(4): 2006 New Rules for the Sale of Pseudoephedrine and other Methamphetamine Precursors Detail-Document#: 220413 (subscription needed) http://www.prescribersletter.com
  6. Deprecated Reference
  7. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  8. Therapeutics Letter #108. Therapeutics Initiative Drugs to Avoid. http://www.ti.ubc.ca/2018/01/04/108-drugs-avoid/

Component-of

acetaminophen/aspirin/pseudoephedrine acetaminophen/brompheniramine/dextromethorphan/pseudoephedrine acetaminophen/chlorpheniramine/dextromethorphan/pseudoephedrine acetaminophen/chlorpheniramine/diphenhydramine/pseudoephedrine acetaminophen/chlorpheniramine/pseudoephedrine acetaminophen/clemastine/fumarate/pseudoephedrine acetaminophen/clemastine/pseudoephedrine acetaminophen/codeine/guaifenesin/pseudoephedrine acetaminophen/dexbrompheniramine/pseudoephedrine acetaminophen/dexchlorpheniramine/pseudoephedrine acetaminophen/dextromethorphan/diphenhydramine/pseudoephedrine acetaminophen/dextromethorphan/doxylamine/guaifenesin/pseudoephedrine acetaminophen/dextromethorphan/doxylamine/pseudoephedrine acetaminophen/dextromethorphan/guaifenesin/pseudoephedrine acetaminophen/dextromethorphan/pseudoephedrine acetaminophen/dextromethorphan/pseudoephedrine/pyrilamine acetaminophen/diphenhydramine/phenylephrine/pseudoephedrine acetaminophen/diphenhydramine/pseudoephedrine acetaminophen/doxylamine/pseudoephedrine acetaminophen/guaifenesin/pseudoephedrine acetaminophen/pseudoephedrine acetaminophen/pseudoephedrine/triprolidine acrivastine/pseudoephedrine activation induced cytidine deaminase/ibuprofen/pseudoephedrine atropine/chlorpheniramine/hyoscyamine/pseudoephedrine/scopolamine azatadine/pseudoephedrine belladonna alkaloid/chlorpheniramine/pseudoephedrine belladonna/belladonna alkaloid/chlorpheniramine/pseudoephedrine brompheniramine/chlophedianol/pseudoephedrine brompheniramine/chlorpheniramine/methscopolamine/phenylephrine/pseudoephedrine brompheniramine/chlorpheniramine/phenylephrine/pseudoephedrine brompheniramine/codeine/pseudoephedrine brompheniramine/dextromethorphan/guaifenesin/pseudoephedrine brompheniramine/dextromethorphan/pseudoephedrine brompheniramine/dihydrocodeine/pseudoephedrine brompheniramine/hydrocodone/pseudoephedrine brompheniramine/pseudoephedrine (Ultrabrom) carbetapentane/citrate/pseudoephedrine carbetapentane/citrate/pseudoephedrine/pyrilamine carbetapentane/guaifenesin/pseudoephedrine carbetapentane/pseudoephedrine carbetapentane/pseudoephedrine/pyrilamine carbinoxamine/dextromethorphan/pseudoephedrine (Cardec-DM, Rondec-DM) carbinoxamine/dextromethorphan/pseudoephedrine/vegf co regulated chemokine 1 carbinoxamine/hydrocodone/pseudoephedrine carbinoxamine/methscopolamine/pseudoephedrine carbinoxamine/pseudoephedrine (Carbiset, Rondec) cetirizine/pseudoephedrine cetirizine/pseudoephedrine/tec kinase chlophedianol/chlorcyclizine/pseudoephedrine chlophedianol/chlorpheniramine/pseudoephedrine chlophedianol/dexbrompheniramine/pseudoephedrine chlophedianol/dexchlorpheniramine/pseudoephedrine chlophedianol/guaifenesin/pseudoephedrine chlophedianol/pseudoephedrine (Clofera) chlophedianol/pseudoephedrine/pyrilamine chlophedianol/pseudoephedrine/triprolidine chlorcyclizine/codeine/pseudoephedrine chlorcyclizine/pseudoephedrine chlorpheniramine/clemastine/pseudoephedrine chlorpheniramine/codeine/pseudoephedrine (Dihistine DH, Novahistine DH) chlorpheniramine/dextromethorphan/guaifenesin/pseudoephedrine chlorpheniramine/dextromethorphan/pseudoephedrine chlorpheniramine/dihydrocodeine/pseudoephedrine chlorpheniramine/guaifenesin/hydrocodone/pseudoephedrine chlorpheniramine/hydrocodone/pseudoephedrine chlorpheniramine/hyoscyamine/pseudoephedrine/scopolamine chlorpheniramine/ibuprofen/pseudoephedrine chlorpheniramine/methscopolamine/phenylephrine/pseudoephedrine chlorpheniramine/methscopolamine/pseudoephedrine chlorpheniramine/phenylpropanolamine/pseudoephedrine chlorpheniramine/pseudoephedrine (Deconamine, Kronofed) chlorpheniramine/pseudoephedrine/zinc acetate citrate/diphenhydramine/pseudoephedrine clemastine/diphenhydramine/pseudoephedrine codeine/dexbrompheniramine/pseudoephedrine codeine/diethylcarbamazine/guaifenesin/pseudoephedrine codeine/guaifenesin/phosphate/pseudoephedrine codeine/guaifenesin/pseudoephedrine (Robitussin DAC) codeine/phosphate/pseudoephedrine codeine/phosphate/pseudoephedrine/pyrilamine codeine/phosphate/pseudoephedrine/triprolidine codeine/pseudoephedrine codeine/pseudoephedrine/pyrilamine codeine/pseudoephedrine/triprolidine (Actifed with codeine) d/guaifenesin/pseudoephedrine desloratadine/pseudoephedrine dexbrompheniramine/dextromethorphan/guaifenesin/pseudoephedrine dexbrompheniramine/dextromethorphan/pseudoephedrine dexbrompheniramine/pseudoephedrine dexchlorpheniramine/dextromethorphan/pseudoephedrine dexchlorpheniramine/guaifenesin/pseudoephedrine dexchlorpheniramine/methscopolamine/pseudoephedrine dexchlorpheniramine/pseudoephedrine dexchlorpheniramine/pseudoephedrine/pyrilamine dextromethorphan/doxylamine/pseudoephedrine dextromethorphan/guaifenesin/nov protein/pseudoephedrine dextromethorphan/guaifenesin/pseudoephedrine (Robitussin CF) dextromethorphan/pseudoephedrine dextromethorphan/pseudoephedrine/pyrilamine dextromethorphan/pseudoephedrine/triprolidine diethylcarbamazine/guaifenesin/pseudoephedrine dihydrocodeine/guaifenesin/pseudoephedrine diphenhydramine/phenylephrine/pseudoephedrine diphenhydramine/pseudoephedrine doxylamine/pseudoephedrine fexofenadine/pseudoephedrine (Allegra-D) guaiacolsulfonate/hydrocodone/pseudoephedrine guaifenesin/hydrocodone/pseudoephedrine guaifenesin/nov protein/pseudoephedrine guaifenesin/pseudoephedrine (Entex PSE, Robitussin PE) guaifenesin/pseudoephedrine/theophylline hydrocodone/pseudoephedrine hydrocodone/pseudoephedrine/triprolidine hyoscyamine/phenylephrine/pseudoephedrine/scopolamine ibuprofen/pseudoephedrine loratadine/pseudoephedrine methscopolamine/pseudoephedrine naproxen/pseudoephedrine phenylephrine/pseudoephedrine pseudoephedrine/pyrilamine pseudoephedrine/triprolidine (Actifed, Allercon)