Pharm

Decongestant

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Decongestant, Systemic Decongestant, Pseudoephedrine, Sudafed, Nexafed

  • Indications
  1. Sinusitis
  2. Upper Respiratory Infection
  • Contraindications
  1. Uncontrolled Hypertension
  2. Coronary Artery Disease
  3. Benign Prostatic Hyperplasia
  • Adverse Effects
  1. Headache
  2. Nausea, Vomiting
  3. Loss of appetite
  4. Cardiac effects
    1. Hypertension
    2. Dysrhythmias (Tachycardia)
  5. CNS stimulation
    1. Seizures
    2. Insomnia
    3. Psychosis
    4. Agitation
  6. Other effects
    1. Cerebral Hemorrhage
    2. Cerebrovascular Accident
  • Medications
  • Systemic Decongestants
  1. Pseudoephedrine (Sudafed)
    1. Available as prescription and over-the-counter in U.S.
    2. U.S. pharmacies keep this behind counter due to Methamphetamine production-related use
    3. Combined with Antihistamines that are suffixed with "-D"
    4. Dosing
      1. Adults: 60 mg PO q6h
      2. Child (30 mg/5ml elixir) - NOT recommended
        1. Ages 6-12 years: 30 mg (5 ml) per dose
        2. Ages 2-5 years: 15 mg (2.5 ml) per dose
  2. Phenylephrine (Sudafed PE)
    1. Available in U.S. OTC products at 10 mg
    2. Combined with Antihistamines that are suffixed with "-PE"
      1. Likely add nothing to Antihistamine efficacy (see below)
    3. No more effective than Placebo for congestion at this dose systemically
      1. FDA has as of 2023, labeled oral Phenylephrine as ineffective
      2. Poor absorption (low Bioavailability) compared with systemic Pseudoephedrine
      3. In contrast, Intranasal Phenylephrine (Intranasal Neo-Synephrine) is effective
      4. Hatton (2007) Ann Pharmacother 41(3):381-90 [PubMed]
  3. Nexafed
    1. Pseudophedrine preparation that turns to thick gel when tablet is disolved
    2. Designed to curb diversion of pseudophedrine to Methamphetamine production
    3. Will require prescription in some U.S. states and quantity that can be sold is limited
    4. (2013) Prescr Lett 20(2): 9
  • Medications
  • Alternative agents (Topical)
  1. Nasal Saline
  2. Limited use of Topical Decongestant (3 days only)
    1. Oxymetazoline (Afrin)
      1. Never use in young children ("One Pill Can Kill")
    2. Intranasal Phenylephrine (Intranasal Neo-Synephrine)
      1. Effective Decongestant, unlike oral Phenylephrine
      2. Safe for short-term use, even in younger patients