Nasal decongestant (sympathomimetic) Pregnancy: Avoid — vasoconstriction may reduce placental blood flow.

Pseudoephedrine

Brand names: Sudafed

Adult dose

Dose: 60 mg every 4–6 hours

Route: Oral

Frequency: Every 4–6 hours (max 4 doses per day)

Max: 240 mg/day

Nasal congestion: 60 mg oral every 4–6 hours. Extended-release: 120 mg every 12 hours. Short-term use only (max 3–5 days). Avoid in hypertension, hyperthyroidism, cardiovascular disease.

Paediatric dose

Route: Oral

Frequency: Every 4–6 hours

Max: 60 mg/day (2–5 years); 120 mg/day (6–11 years)

Concentration: 30 mg/ml

2–5 years: 15 mg every 6 hours (max 60 mg/day). 6–11 years: 30 mg every 4–6 hours (max 120 mg/day). 12–17 years: adult dose. MHRA advice: cold/cough medicines containing decongestants not recommended for children <6 years.

Dose adjustments

Renal

Reduce dose or avoid in renal impairment.

Hepatic

Avoid in severe hepatic impairment.

Clinical pearls

OTC availability — but regulated (pseudoephedrine precursor for methamphetamine manufacture)
Short-term use only — rebound congestion risk
MHRA 2009: not recommended in children <6 years
Topical decongestants (xylometazoline nasal drops) more effective and fewer systemic effects but max 7 days use
Avoid in patients with uncontrolled hypertension, cardiac arrhythmias, or prostate disease

Contraindications

Hypertension
Hyperthyroidism
Cardiovascular disease
Pheochromocytoma
Angle-closure glaucoma
MAO inhibitors within 14 days

Side effects

Hypertension
Tachycardia and palpitations
Insomnia
Headache
Urinary retention (in BPH)
Anxiety and tremor

Interactions

MAOIs — hypertensive crisis (contraindicated within 14 days)
Antihypertensives — reduced efficacy
Beta-blockers — hypertension risk due to unopposed alpha stimulation

Monitoring

Blood pressure
Heart rate

Reference: BNFc; BNF; MHRA guidance on cold medicines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways