Duration of Pseudoephedrine Use
Pseudoephedrine should be used for a maximum of 7 days for nasal congestion, and patients should be counseled to stop use if symptoms do not improve within this timeframe or if they occur with fever. 1
FDA-Approved Duration
The FDA drug label explicitly states that patients should stop use and ask a doctor if symptoms do not improve within 7 days or occur with a fever, establishing 7 days as the maximum recommended duration without medical supervision. 1
Dosing Schedule Within This Period
- Adults and children ≥12 years: Take 2 tablets (60 mg total) every 4-6 hours, not exceeding 8 tablets in 24 hours 1
- Children 6-11 years: Take 1 tablet (30 mg) every 4-6 hours, not exceeding 4 tablets in 24 hours 1
- Children <6 years: Do not use 1
Important Safety Considerations During Use
Patients with cardiovascular risk factors require special attention. The American College of Cardiology recommends using pseudoephedrine for the shortest duration possible, particularly in patients with cardiovascular concerns. 2
Specific Patient Populations:
- Hypertensive patients: While pseudoephedrine causes modest increases in systolic blood pressure (approximately 1 mmHg) and heart rate (2.83 beats/min), patients with controlled hypertension should be monitored during use 3
- Patients with uncontrolled hypertension, cardiovascular disease, or cerebrovascular disease: Should avoid pseudoephedrine entirely 3
- Patients with arrhythmias, angina, coronary artery disease, hyperthyroidism, bladder neck obstruction, or glaucoma: Should avoid use 3
Frequency Limitations for Chronic Conditions
For patients requiring repeated decongestant use (such as those with chronic rhinitis or migraine patients needing occasional relief), limit pseudoephedrine to no more than twice weekly to avoid medication-overuse complications. 3
Alternative for Short-Term Relief
If nasal congestion requires treatment beyond 7 days, patients should consult a physician rather than continuing pseudoephedrine. 1 For acute short-term relief (≤3 days), topical oxymetazoline may be considered as an alternative, though it carries its own risk of rhinitis medicamentosa with prolonged use. 2
Critical Warnings
- Never use if currently taking MAOIs or within 2 weeks of stopping MAOI therapy 1
- Stop immediately if nervousness, dizziness, or sleeplessness occur 1
- Research demonstrates efficacy is maintained with both single and multiple doses over 3 days, but there is limited safety data for extended use beyond 7 days 4