What is the recommended dosing for Mucinex D (guaifenesin and pseudoephedrine)?

Recommended Dosing for Mucinex D (Guaifenesin and Pseudoephedrine)

The recommended dosing for Mucinex D (guaifenesin and pseudoephedrine) for adults and children 12 years and over is 2 tablets every 4 to 6 hours, not exceeding 8 tablets in 24 hours; for children 6-11 years, the dose is 1 tablet every 4 to 6 hours, not exceeding 4 tablets in 24 hours. 1

Adult and Pediatric Dosing

Adults and Children 12 Years and Older

• Take 2 tablets every 4 to 6 hours 1
• Do not take more than 8 tablets in 24 hours 1
• Extended-release formulations may allow for 12-hour dosing, providing greater convenience compared to immediate-release formulations that require dosing every 4 hours 2

Children 6 to 11 Years

• Take 1 tablet every 4 to 6 hours 1
• Do not take more than 4 tablets in 24 hours 1

Children Under 6 Years

• Mucinex D is not recommended for use in children under 6 years of age 1
• Use of oral decongestants in infants and young children has been associated with adverse effects including agitated psychosis, ataxia, hallucinations, and even death 3

Component-Specific Information

Guaifenesin Component

• Guaifenesin is an expectorant that acts by loosening mucus in the airways and making coughs more productive 4
• Standard guaifenesin dosing (when not in combination with pseudoephedrine):
  • Adults and children 12 years and over: 200-400 mg every 4 hours, up to 6 times daily 5, 4
  • Children 6 to under 12 years: 100-200 mg every 4 hours 5
  • Children 2 to under 6 years: 50-100 mg every 4 hours 5

Pseudoephedrine Component

• Pseudoephedrine is an oral decongestant effective at relieving nasal congestion in patients with allergic and nonallergic rhinitis 3
• Common side effects may include insomnia, loss of appetite, irritability, and palpitations 3
• Pseudoephedrine is subject to sales restrictions in the United States due to its potential use in methamphetamine production 3

Precautions and Contraindications

• Use oral decongestants with caution in patients with:

  • Hypertension (rarely affects normotensive patients but may affect those with controlled hypertension) 3
  • Cerebrovascular or cardiovascular disease 3
  • Hyperthyroidism 3
  • Closed-angle glaucoma 3
  • Bladder neck obstruction 3
  • Concomitant use of caffeine and stimulants (may increase adverse events) 3

• Topical decongestants should not be used for more than 3-5 days to avoid rebound congestion and rhinitis medicamentosa 3

Clinical Efficacy and Considerations

• Guaifenesin has demonstrated clinical efficacy most widely in chronic respiratory conditions where excess mucus production and cough are more stable symptoms 4
• Extended-release guaifenesin formulations provide 12-hour dosing, which is more convenient than the 4-hour dosing required with immediate-release formulations 2
• Guaifenesin is generally well-tolerated with a favorable safety profile in adult and pediatric populations 4, 6
• For symptomatic relief of acute bacterial rhinosinusitis, clinicians may recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation rather than expectorants 3

Common Pitfalls and Caveats

• Elevation of blood pressure after taking oral decongestants is rare in normotensive patients and only occasional in patients with controlled hypertension, but patients should still be monitored for changes in blood pressure 3
• Continuous use of topical decongestants beyond 3-5 days can lead to rebound congestion 3
• When used in combination with cough suppressants like dextromethorphan, there is a potential risk of increased airway obstruction 7
• Although guaifenesin is commonly used as an expectorant, some studies question its efficacy for certain respiratory conditions 7