Sudafed (Pseudoephedrine) Dosing for Nasal and Chest Congestion
For adults and children 12 years and older, take 60 mg (2 tablets of 30 mg) every 4-6 hours, not exceeding 240 mg (8 tablets) in 24 hours; children ages 6-11 should take 30 mg (1 tablet) every 4-6 hours, not exceeding 120 mg (4 tablets) in 24 hours. 1
Standard Dosing Regimen
Adults and children ≥12 years:
- 60 mg every 4-6 hours (standard formulation contains 30 mg per tablet, so take 2 tablets per dose) 1
- Maximum daily dose: 240 mg (8 tablets) in 24 hours 1
- This 60 mg dose provides maximal nasal decongestion without cardiovascular effects 2
Children 6-11 years:
Children under 6 years:
- Do not use 1
Clinical Efficacy
- Pseudoephedrine 60 mg is the optimal single adult dose, achieving maximal nasal decongestion through vasoconstriction without cardiovascular or other unwanted effects 2
- Efficacy is demonstrated by both objective measures (reduced nasal airway resistance) and subjective symptom improvement within hours of administration 3
- The decongestant effect begins within 1 hour and persists for 4-6 hours, supporting the every 4-6 hour dosing interval 3, 2
Important Safety Considerations
Use with extreme caution or avoid in patients with:
- Hypertension, cardiovascular disease, cerebrovascular disease, or angina 4, 5, 6
- Cardiac arrhythmias 5
- Hyperthyroidism 4
- Closed-angle glaucoma 4
- Bladder neck obstruction or prostatic hypertrophy 4
Cardiovascular effects:
- Doses of 120 mg and 180 mg produce small but statistically significant increases in pulse rate (2-4 beats per minute) and systolic blood pressure 3, 2
- The 60 mg dose does not produce significant cardiovascular effects 2
- Severe cardiovascular events (including angina) can occur even at low doses and in patients without pre-existing pathology 6, 7
Other side effects:
- Insomnia, irritability, and palpitations may occur 4, 5
- Avoid concurrent use with caffeine or other stimulants, which may increase adverse effects 8
Clinical Pearls
- For allergic rhinitis with congestion, intranasal corticosteroids are more effective than oral decongestants and should be considered first-line therapy 5
- For acute congestion from common cold, pseudoephedrine is appropriate for short-term symptomatic relief 3
- Combination therapy with an antihistamine (such as desloratadine or diphenhydramine) plus pseudoephedrine provides enhanced relief of nasal congestion compared to either agent alone 8, 9
- Duration of use: While effective for multiple days, limit use to the shortest duration necessary given cardiovascular risks 7
- Topical decongestants (such as oxymetazoline) provide more rapid relief but should be limited to 3-5 days maximum to avoid rebound congestion 5
Common Pitfalls to Avoid
- Do not exceed recommended doses, as higher doses (120-180 mg) increase cardiovascular risks without improving decongestant efficacy 2
- Do not use in children under 6 years of age 1
- Monitor blood pressure in patients with hypertension, as even therapeutic doses can cause small increases 5, 3
- Be aware that severe adverse events can occur unpredictably, even in patients without known risk factors 7