From the Guidelines
Pseudoephedrine should not be used for more than 3-7 days for nasal congestion due to the risk of rebound congestion and potential side effects. The study by 1 highlights the importance of using oral decongestants like pseudoephedrine with caution, as they can result in side effects such as insomnia, loss of appetite, irritability, and palpitations. Key points to consider when using pseudoephedrine include:
- Elevation of blood pressure after taking an oral decongestant is very rarely noted in normotensive patients and only occasionally in patients with controlled hypertension
- Concomitant use of caffeine and stimulants may be associated with an increase in adverse events
- Oral decongestants should be used with caution in patients with certain conditions, such as cerebrovascular or cardiovascular disease, hyperthyroidism, closed-angle glaucoma, and bladder neck obstruction
- The typical adult dose is 60mg every 4-6 hours or 120mg in extended-release form every 12 hours, not exceeding 240mg in 24 hours. If congestion persists beyond a week, it is recommended to consult a healthcare provider as this may indicate a condition requiring different treatment. Alternative treatments like nasal corticosteroids, saline rinses, or addressing underlying causes may be more appropriate and safer for long-term management.
From the Research
Pseudoephedrine Usage Duration
- Pseudoephedrine is a widely used oral decongestant for the treatment of nasal congestion associated with common cold and allergy 2.
- The study 2 demonstrated the safety and efficacy of pseudoephedrine after single and multiple doses in patients with upper respiratory tract infection (URTI), with a treatment duration of three days.
- There is no clear evidence from the provided studies to suggest a maximum safe duration for taking pseudoephedrine, but it is generally recommended to use it as directed and for a limited period.
- Another study 3 found that therapeutic doses of pseudoephedrine did not adversely affect control of hypertension in patients with controlled, uncomplicated hypertension, over a period of three days.
Potential Risks and Considerations
- Pseudoephedrine has central nervous system (CNS) stimulant properties and can be used for non-medical purposes, such as an appetite reducer or to improve concentration 4.
- The misuse of pseudoephedrine can lead to problems, and legal restrictions on its sale may help reduce its misuse 4.
- Rebound congestion and rhinitis medicamentosa are potential risks associated with the prolonged use of nasal decongestants, including pseudoephedrine 5.
- However, the concept of rhinitis medicamentosa is rejected by some authors in the absence of scientific evidence from patients with rhinosinusitis 5.
Decongestant Alternatives
- Oxymetazoline, a topical nasal decongestant, has been shown to provide relief of nasal symptoms for up to 12 hours 6.
- The study 6 demonstrated the efficacy of oxymetazoline in patients with acute coryzal rhinitis, with significant improvements in subjective nasal congestion and objective measures of nasal patency.