Pseudoephedrine Dosing for Adults
For typical adults without significant medical history, the recommended dose is 60 mg every 4-6 hours, not exceeding 240 mg in 24 hours (8 tablets of 30 mg or 4 tablets of 60 mg). 1
Standard Adult Dosing
- Adults and children 12 years and over should take 2 tablets (60 mg total) every 4 to 6 hours, with a maximum of 8 tablets in 24 hours 1
- The 60 mg dose represents the optimal single adult dose, achieving maximal nasal decongestion without cardiovascular or other unwanted effects 2
- This dosing regimen is effective for treating nasal congestion associated with both allergic rhinitis and common cold 3, 4
Efficacy Evidence
- Pseudoephedrine 60 mg significantly reduces nasal airway resistance compared to placebo, with effects lasting 3-4 hours after a single dose 4
- Doses of 60 mg, 120 mg, and 180 mg all provide similar protective effects against histamine-induced nasal congestion, but higher doses offer no additional benefit 2
- Multiple doses over 3 days maintain efficacy without tolerance development 4
Cardiovascular Considerations
- The 60 mg dose does not produce statistically significant increases in pulse rate or blood pressure in normotensive patients 2
- Higher doses (120 mg and 180 mg) produce small but statistically significant increases in pulse and systolic blood pressure 2
- Blood pressure elevation is very rarely noted in normotensive patients and only occasionally in those with controlled hypertension, though monitoring is recommended 3
Important Contraindications and Precautions
Use with extreme caution or avoid entirely in patients with:
- Cerebrovascular or cardiovascular disease 3
- Hyperthyroidism 3
- Closed-angle glaucoma 3
- Bladder neck obstruction 3
Additional warnings:
- Concomitant use with caffeine and stimulants (such as ADHD medications) may increase adverse events 3
- Pseudoephedrine is more effective than phenylephrine, which has not been well-established as an oral decongestant 3
Pediatric Dosing (for reference)
- Children ages 6 to 11 years: 1 tablet (30 mg) every 4 to 6 hours, maximum 4 tablets in 24 hours 1
- Do not use in children under 6 years of age due to risk of agitated psychosis, ataxia, hallucinations, and even death 3, 1
Common Pitfalls to Avoid
- Do not exceed 240 mg in 24 hours to minimize cardiovascular side effects 1, 2
- Avoid assuming phenylephrine is equivalent—it is less effective and not adequately proven as an oral decongestant 3
- Do not combine with other stimulants without careful monitoring for tachyarrhythmias, insomnia, and hyperactivity 3
- Monitor blood pressure in all patients due to individual variation in response, even though elevation is uncommon 3