Pseudoephedrine
Pseudoephedrine hydrochloride
Brand names:Sudafed, Drixoral, Genaphed
An oral sympathomimetic decongestant with good oral bioavailability and predictable nasal decongestant effect. Pseudoephedrine is significantly more effective than oral phenylephrine for nasal congestion. Behind-the-counter status in the US due to methamphetamine precursor concerns; specific state regulations may apply. Operationally relevant in deployment medicine for sinus and Eustachian tube dysfunction at altitude or in flight operations.
Pharmacology and Actions
Pseudoephedrine is a mixed direct and indirect sympathomimetic with alpha-1, alpha-2, and beta-adrenergic effects. The primary clinical effect is alpha-1 mediated vasoconstriction of nasal mucosal vessels, reducing mucosal swelling and nasal congestion. The drug also has mild bronchodilator effects from beta-2 stimulation and mild CNS stimulation. Onset is within 30 minutes with sustained effect for 4 to 6 hours (immediate release) or 12 to 24 hours (extended release).
Indications
- Nasal and sinus congestion from upper respiratory infection, allergic rhinitis, or sinusitis
- Eustachian tube dysfunction (prophylaxis before flight or diving)
- Adjunct to allergy management when antihistamines alone are insufficient
- Operational medicine for sinus pressure management at altitude
Absolute Contraindications
- Known pseudoephedrine or sympathomimetic allergy
- Severe hypertension or coronary artery disease
- Hyperthyroidism
- Closed-angle glaucoma
- Concurrent MAOI use within 14 days
- Urinary retention from prostatic hypertrophy
Precautions and Side Effects
CNS stimulation including insomnia, anxiety, and tremor is common. Elevated blood pressure and tachycardia can occur, particularly with higher doses or in hypertensive patients. Urinary retention may worsen in patients with BPH. Drug interactions with MAOIs can produce hypertensive crisis. Avoid use in the evening due to sleep disruption. Pseudoephedrine purchases in the US are tracked due to methamphetamine precursor regulations.
Adult Dosing
Pediatric Dosing
Pediatric dosing: 4 to 5 years, 15 mg PO every 6 hours. 6 to 11 years, 30 mg PO every 6 hours. 12 years and older, adult dosing. Maximum 4 doses per 24 hours. Avoid in children under 4 due to safety concerns with OTC cough and cold medications.
Pharmacokinetics
Peak Effect: PO: 1 to 2 hours
Duration: 4 to 6 hours (IR); 12 to 24 hours (ER)
Storage and Handling
Store at controlled room temperature (15 to 30 degrees Celsius). Protect from moisture. Pseudoephedrine is regulated under the Combat Methamphetamine Epidemic Act; track inventory and document dispensing as required by state law.
Reconstitution:
Tablets and liquid require no reconstitution.
TCCC and TECC Role
Pseudoephedrine is not a TCCC trauma management agent but is operationally important in deployment medicine and flight medicine for sinus and Eustachian tube dysfunction. Aviation personnel particularly benefit from pseudoephedrine for managing altitude-related sinus pressure during descent or ascent. The drug also has utility for upper respiratory infections that affect mission capability when antihistamines alone are not adequate for congestion.
Pseudoephedrine is the decongestant that actually works orally. The 30 to 60 mg dose every 6 hours produces reliable nasal and sinus decongestion within 30 minutes. For flight personnel managing barosinusitis or barotrauma risk, prophylactic pseudoephedrine 30 minutes before descent is operationally effective. Watch for the CNS stimulation, which makes evening dosing problematic for sleep. The behind-the-counter status in the US is a real logistics issue for stocking deployment kits; pharmacy purchase records are tracked under the Combat Methamphetamine Epidemic Act.
Dosing pseudoephedrine in the evening and causing insomnia. The CNS stimulation persists for 4 to 6 hours after a dose. Schedule doses earlier in the day to avoid sleep disruption. The other common error is using pseudoephedrine in patients with poorly controlled hypertension; the drug can produce significant blood pressure elevation, particularly in combination with other sympathomimetics or stimulants.
This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.
Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
If this content is being viewed during a medical emergency, call 911 immediately and follow the direction of your local emergency dispatch and medical control. Do not use this reference as a substitute for emergency medical services.
Drug information evolves. Last reviewed dates and source citations are provided for each entry. Confirm currency against the cited source before clinical use.
Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Pseudoephedrine
State Specific (Varies)| PO | Immediate-release: 30 to 60 mg PO every 4 to 6 hours, maximum 240 mg/24 hours. Extended-release: 120 mg PO every 12 hours or 240 mg PO every 24 hours. (30 minutes (immediate release)) |