pseudoephedrine

pseudoephedrine

(soo dow e fed' rin)

pseudoephedrine hydrochloride (d-isoephedrine hydrochloride)

Cenafed, Decofed, Efidac/24, Eltor (CAN), Sudafed, Sudodrin, Triaminic Allergy Congestion and others, Unifed

pseudoephedrine sulfate

Drixoral Non-Drowsy Formula, ElixSure Children's Congestion

Pregnancy Category C

Drug classes

Nasal decongestant

Sympathomimetic amine

Therapeutic actions

Effects are mediated by alpha-adrenergic receptors; causes vasoconstriction in mucous membranes of nasal passages, resulting in their shrinkage, which promotes drainage and improves ventilation.

Indications

·        Temporary relief of nasal congestion caused by the common cold, hay fever, other respiratory allergies

·        Nasal congestion associated with sinusitis

·        Promotes nasal or sinus drainage

·        Relief of eustachian tube congestion

Contraindications and cautions

·        Contraindicated with MAOI therapy, allergy or idiosyncrasy to sympathomimetic amines, severe hypertension and CAD.

·        Use cautiously with hyperthyroidism, diabetes mellitus, arteriosclerosis, ischemic heart disease, increased IOP, prostatic hypertrophy, lactation, pregnancy.

Available forms

Tablets—30, 60 mg; CR tablets—240 mg; ER tablets—120 mg; chewable tablets—15 mg; capsules—30, 60 mg; liquid—15, 30 mg/5 mL; drops—7.5 mg/0.8 mL; syrup—15 mg/5 mL

Dosages

ADULTS AND CHILDREN > 12 YR

60 mg q 4–6 hr PO (ER, 120 mg PO q 12 hr; 240 mg/day CR); do not exceed 240 mg in 24 hr.

PEDIATRIC PATIENTS 3–12 MO

3 drops/kg q 4–6 hr PO, up to four doses per day.

PEDIATRIC PATIENTS 1–2 YR

7 drops (0.02 mL/kg) q 4–6 hr PO; up to 4 doses per day.

PEDIATRIC PATIENTS 2–5 YR

15 mg as syrup q 4–6 hr PO; do not exceed 60 mg in 24 hr.

PEDIATRIC PATIENTS 6–12 YR

30 mg q 4–6 hr PO; do not exceed 120 mg in 24 hr.

GERIATRIC PATIENTS

These patients are more likely to experience adverse reactions; use with caution.

Pharmacokinetics

Route	Onset	Duration
Oral	30 min	4–6 hr

Metabolism: Hepatic; T_1/2: 7 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

Adverse effects

·        CNS: Fear, anxiety, tenseness, restlessness, headache, light-headedness, dizziness, drowsiness, tremors, insomnia, hallucinations, psychological disturbances, prolonged psychosis, seizures, CNS depression, weakness, blurred vision, ocular irritation, tearing, photophobia, orofacial dystonia

·        CV: Hypertension, arrhythmias, CV collapse with hypotension, palpitations, tachycardia, precordial pain

·        Dermatologic: Pallor, sweating

·        GI: Nausea, vomiting, anorexia

·        GU: Dysuria, urinary retention in BPH

·        Respiratory: Respiratory difficulty

Interactions

Drug-drug

·        Increased hypertension with MAOIs, guanethidine, furazoladine

·        Increased duration of action with urinary alkalinizers (potassium citrate, sodium citrate, sodium lactate, tromethamine, sodium acetate, sodium bicarbonate)

·        Decreased therapeutic effects and increased elimination of pseudoephedrine with urinary acidifiers (ammonium chloride, sodium acid phosphate, potassium phosphate)

·        Decreased antihypertensive effects of methyldopa

Nursing considerations

Assessment

·        History: Allergy or idiosyncrasy to sympathomimetic amines, severe hypertension and CAD, hyperthyroidism, diabetes mellitus, arteriosclerosis, increased IOP, prostatic hypertrophy, pregnancy, lactation

·        Physical: Skin color, T; reflexes, affect, orientation, peripheral sensation, vision; BP, P, auscultation; R, adventitious sounds; urinary output, bladder percussion, prostate palpation

Interventions

·        WARNING: Administer cautiously to patients with CV disease, diabetes mellitus, hyperthyroidism, increased IOP, hypertension, and to patients > 60 yr who may have increased sensitivity to sympathomimetic amines.

·        Avoid prolonged use; underlying medical problems may be causing the congestion.

·        Monitor CV effect carefully; hypertensive patients who take this drug may experience changes in BP because of the additional vasoconstriction. However, if a nasal decongestant is needed, pseudoephedrine is the drug of choice.

Teaching points

·        Do not exceed the recommended daily dose; serious overdose can occur. Use caution when using more than one over-the-counter preparation because many of these drugs contain pseudoephedrine, and unintentional overdose may occur.

·        Avoid prolonged use because underlying medical problems can be disguised.

·        You may experience these side effects: Dizziness, weakness, restlessness, light-headedness, tremors (avoid driving or performing hazardous tasks).

·        Report palpitations, nervousness, sleeplessness, sweating.

Adverse effects in Italic are most common; those in Bold are life-threatening.