Pseudo Ephedrine

pseudoephedrine (soo dow e fed' rin)

pseudoephedrine hydrochloride (d-isoephedrine hydrochloride) Cenafed, Decofed, Efidac/24, Eltor (CAN), Sudafed, Sudodrin, Triaminic Allergy Congestion, and others

pseudoephedrine sulfate Drixoral Non-Drowsy Formula 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

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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

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Contraindicated with MAOI therapy, allergy or idiosyncrasy to sympathomimetic amines, severe hypertension and coronary artery disease. 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 Dosages ADULTS

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

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3–12 mo: 3 drops/kg q 4–6 hr PO, up to 4 doses per day.

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1–2 yr: 7 drops (0.02 mL/kg) q 4–6 hr PO; up to 4 doses per day. 2–5 yr: 15 mg as syrup q 4–6 hr PO; do not exceed 60 mg in 24 hr. 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 Oral

Onset 30 min

Duration 4–6 hr

Metabolism: Hepatic; T1/2: 7 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects

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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

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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

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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

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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. These side effects may occur: 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.