Pseudoephedrine hydrochloride

How it works

Pseudoephedrine is a sympathomimetic that stimulates alpha-adrenergic receptors on nasal blood vessels, causing vasoconstriction that reduces mucosal swelling and improves nasal airflow.

Prescribing in practice

• Avoid in uncontrolled hypertension, severe coronary artery disease and with or within two weeks of monoamine oxidase inhibitors, as the combination can precipitate a hypertensive crisis.
• Limit to short-term use and use cautiously in diabetes, hyperthyroidism, prostatic enlargement, closed-angle glaucoma and cardiovascular disease; it can cause insomnia, restlessness and palpitations.
• Patients should be aware of rare but serious reversible cerebral vasoconstriction and posterior reversible encephalopathy syndromes prompting MHRA advice to stop if severe headache occurs.

Monitoring

No routine laboratory monitoring is required, but check blood pressure in at-risk patients and review that use remains short-term.

Counselling the patient

• Use it for only a few days; take the last dose well before bedtime as it can keep you awake.
• Stop and seek advice if you develop a sudden severe headache, visual disturbance or palpitations.
• Do not use it if you have high blood pressure or take antidepressants without checking first.

Evidence & guidelines

Oral pseudoephedrine is a long-established decongestant for short-term symptomatic relief, with cardiovascular and neurological cautions reinforced by recent MHRA safety advice and detailed in the SPC.