pseudoephedrine (Sudafed, Afrin, Drixoral, SudoGest)
Introduction
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:
- renal failure
- uncontrolled hypertension[3]
- diabetes
- ischemic heart disease
- increased intraocular pressure
- prostatic hypertrophy
- urinary retention
- thyroid disease
Dosage
- 60 mg PO every 4-6 hours.
- 30 mg/dose if 6-13 yo.
- 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
- onset of action is within 30 minutes when taken on an empty stomach
- duration of action is 3 hours with immediate-release preparations & 8-12 hours with sustained-release preparations
elimination via liver
Adverse effects
- nervousness
- insomnia
- irritability
- tachycardia: ave increase in heart rate 2.3 beats/min[4]
- increase in systolic blood pressure 1 mm Hg[4]
- urinary retention
- may constrict smooth muscle of the bladder neck & prostatic urethra & exacerbate BPH (GRS9)[7]
Drug interactions
- MAO inhibitors: severe headache, hypertension & hypertensive crisis
- phenothiazines may antagonize effects of decongestants
- tricyclic antidepressants may increase pressor effects
- agents which acidify the urine increase urinary secretion
- agents which alkalinize the urine decrease elimination & may result in toxic accumulation
- decreased effect of terazosin & other alpha adrenergic agonists
Laboratory
- ephedrine+pseudoephedrine in stool
- ephedrine+pseudoephedrine in meconium
- ephedrine+pseudoephedrine in vitreous fluid
Mechanism of action
- indirect-acting alpha & beta adrenergic receptor agonist
- 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]
More general terms
Additional terms
Component of
- chlophedianol/pseudoephedrine/pyrilamine
- chlophedianol/dexbrompheniramine/pseudoephedrine
- atropine/chlorpheniramine/hyoscyamine/pseudoephedrine/scopolamine
- phenylephrine/pseudoephedrine
- hyoscyamine/phenylephrine/pseudoephedrine/scopolamine
- hydrocodone/pseudoephedrine/triprolidine
- guaifenesin/pseudoephedrine/theophylline
- guaifenesin/nov protein/pseudoephedrine
- guaiacolsulfonate/hydrocodone/pseudoephedrine
- doxylamine/pseudoephedrine
- diphenhydramine/phenylephrine/pseudoephedrine
- diethylcarbamazine/guaifenesin/pseudoephedrine
- dextromethorphan/pseudoephedrine/triprolidine
- dextromethorphan/guaifenesin/nov protein/pseudoephedrine
- dextromethorphan/doxylamine/pseudoephedrine
- dexchlorpheniramine/pseudoephedrine/pyrilamine
- dexbrompheniramine/dextromethorphan/pseudoephedrine
- dexbrompheniramine/dextromethorphan/guaifenesin/pseudoephedrine
- d/guaifenesin/pseudoephedrine
- codeine/phosphate/pseudoephedrine/triprolidine
- codeine/phosphate/pseudoephedrine/pyrilamine
- codeine/phosphate/pseudoephedrine
- codeine/guaifenesin/phosphate/pseudoephedrine
- codeine/diethylcarbamazine/guaifenesin/pseudoephedrine
- codeine/dexbrompheniramine/pseudoephedrine
- clemastine/diphenhydramine/pseudoephedrine
- citrate/diphenhydramine/pseudoephedrine
- chlorpheniramine/pseudoephedrine/zinc acetate
- chlorpheniramine/phenylpropanolamine/pseudoephedrine
- chlorpheniramine/methscopolamine/phenylephrine/pseudoephedrine
- chlorpheniramine/hyoscyamine/pseudoephedrine/scopolamine
- chlorpheniramine/dextromethorphan/guaifenesin/pseudoephedrine
- chlorpheniramine/clemastine/pseudoephedrine
- chlorcyclizine/pseudoephedrine
- chlophedianol/pseudoephedrine/triprolidine
- chlophedianol/chlorpheniramine/pseudoephedrine
- chlophedianol/chlorcyclizine/pseudoephedrine
- carbinoxamine/methscopolamine/pseudoephedrine
- carbinoxamine/hydrocodone/pseudoephedrine
- carbinoxamine/dextromethorphan/pseudoephedrine/vegf co regulated chemokine 1
- carbetapentane/citrate/pseudoephedrine/pyrilamine
- carbetapentane/citrate/pseudoephedrine
- brompheniramine/chlorpheniramine/methscopolamine/phenylephrine/pseudoephedrine
- brompheniramine/chlophedianol/pseudoephedrine
- belladonna alkaloid/chlorpheniramine/pseudoephedrine
- azatadine/pseudoephedrine
- acetaminophen/doxylamine/pseudoephedrine
- acetaminophen/diphenhydramine/phenylephrine/pseudoephedrine
- acetaminophen/dextromethorphan/doxylamine/guaifenesin/pseudoephedrine
- acetaminophen/dextromethorphan/diphenhydramine/pseudoephedrine
- acetaminophen/dexchlorpheniramine/pseudoephedrine
- acetaminophen/clemastine/fumarate/pseudoephedrine
- acetaminophen/chlorpheniramine/diphenhydramine/pseudoephedrine
- acetaminophen/brompheniramine/dextromethorphan/pseudoephedrine
- acetaminophen/aspirin/pseudoephedrine
- methscopolamine/pseudoephedrine
- dihydrocodeine/guaifenesin/pseudoephedrine
- dexchlorpheniramine/methscopolamine/pseudoephedrine
- chlorpheniramine/methscopolamine/pseudoephedrine
- chlorpheniramine/dihydrocodeine/pseudoephedrine
- chlorcyclizine/codeine/pseudoephedrine
- carbetapentane/pseudoephedrine/pyrilamine
- carbetapentane/pseudoephedrine
- carbetapentane/guaifenesin/pseudoephedrine
- brompheniramine/dihydrocodeine/pseudoephedrine
- acrivastine/pseudoephedrine
- acetaminophen/clemastine/pseudoephedrine
- brompheniramine/chlorpheniramine/phenylephrine/pseudoephedrine
- activation induced cytidine deaminase/ibuprofen/pseudoephedrine
- ibuprofen/pseudoephedrine
- hydrocodone/pseudoephedrine
- guaifenesin/hydrocodone/pseudoephedrine
- diphenhydramine/pseudoephedrine
- dextromethorphan/pseudoephedrine/pyrilamine
- dextromethorphan/pseudoephedrine
- dexchlorpheniramine/pseudoephedrine
- dexchlorpheniramine/dextromethorphan/pseudoephedrine
- dexchlorpheniramine/guaifenesin/pseudoephedrine
- codeine/pseudoephedrine/pyrilamine
- chlorpheniramine/hydrocodone/pseudoephedrine
- chlorpheniramine/guaifenesin/hydrocodone/pseudoephedrine
- chlorpheniramine/ibuprofen/pseudoephedrine
- chlorpheniramine/dextromethorphan/pseudoephedrine
- codeine/pseudoephedrine
- chlophedianol/pseudoephedrine (Clofera)
- chlophedianol/dexchlorpheniramine/pseudoephedrine
- chlophedianol/guaifenesin/pseudoephedrine
- pseudoephedrine/pyrilamine
- brompheniramine/hydrocodone/pseudoephedrine
- brompheniramine/dextromethorphan/guaifenesin/pseudoephedrine
- brompheniramine/codeine/pseudoephedrine
- brompheniramine/dextromethorphan/pseudoephedrine
- belladonna/belladonna alkaloid/chlorpheniramine/pseudoephedrine
- acetaminophen/pseudoephedrine/triprolidine
- acetaminophen/diphenhydramine/pseudoephedrine
- acetaminophen/codeine/guaifenesin/pseudoephedrine
- acetaminophen/guaifenesin/pseudoephedrine
- acetaminophen/chlorpheniramine/dextromethorphan/pseudoephedrine
- acetaminophen/chlorpheniramine/pseudoephedrine
- acetaminophen/dextromethorphan/guaifenesin/pseudoephedrine
- acetaminophen/dextromethorphan/doxylamine/pseudoephedrine
- acetaminophen/dextromethorphan/pseudoephedrine/pyrilamine
- acetaminophen/pseudoephedrine
- acetaminophen/dextromethorphan/pseudoephedrine
- naproxen/pseudoephedrine
- loratadine/pseudoephedrine
- dexbrompheniramine/pseudoephedrine
- desloratadine/pseudoephedrine
- cetirizine/pseudoephedrine/tec kinase
- cetirizine/pseudoephedrine
- acetaminophen/dexbrompheniramine/pseudoephedrine
- pseudoephedrine/triprolidine (Actifed, Allercon)
- codeine/pseudoephedrine/triprolidine (Actifed with codeine)
- carbinoxamine/dextromethorphan/pseudoephedrine (Cardec-DM, Rondec-DM)
- carbinoxamine/pseudoephedrine (Carbiset, Rondec)
- chlorpheniramine/codeine/pseudoephedrine (Dihistine DH, Novahistine DH)
- dextromethorphan/guaifenesin/pseudoephedrine (Robitussin CF)
- codeine/guaifenesin/pseudoephedrine (Robitussin DAC)
- brompheniramine/pseudoephedrine (Ultrabrom)
- chlorpheniramine/pseudoephedrine (Deconamine, Kronofed)
- guaifenesin/pseudoephedrine (Entex PSE, Robitussin PE)
- fexofenadine/pseudoephedrine (Allegra-D)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ 3.0 3.1 Prescriber's Letter 10(10):60 2003
- ↑ 4.0 4.1 4.2 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/7807033 - ↑ 5.0 5.1 Prescriber's Letter 13(4): 2006 New Rules for the Sale of Pseudoephedrine and other Methamphetamine Precursors Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220413&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 6.0 6.1 6.2 Deprecated Reference
- ↑ 7.0 7.1 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 - ↑ 8.0 8.1 Therapeutics Letter #108. Therapeutics Initiative Drugs to Avoid. http://www.ti.ubc.ca/2018/01/04/108-drugs-avoid/
Database
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5032
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=7028
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=62946
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=9581
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=62945
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=62947
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=9457