Editing Pseudoephedrine (section)

==Medical uses==

===Nasal congestion===
{{More citations needed section|date=December 2011}}

Pseudoephedrine is a [[sympathomimetic]] and is well-known for shrinking swollen nasal mucous membranes, so it is often used as a [[decongestant]]. It reduces tissue [[hyperemia]], [[edema]], and [[nasal congestion]] commonly associated with [[common cold|colds]] or [[allergy|allergies]]. Other beneficial effects may include increasing the drainage of [[Paranasal sinus|sinus]] secretions, and opening of obstructed [[Eustachian tube]]s. The same [[vasoconstriction]] action can also result in [[hypertension]], which is a noted side effect of pseudoephedrine.

Pseudoephedrine can be used either as oral or as [[topical decongestant]]. Due to its [[psychostimulant|stimulating]] qualities, however, the oral preparation is more likely to cause adverse effects, including [[urinary retention]].<ref>{{cite web|url=https://www.auanet.org/education/urinary-incontinence.cfm|title=American Urological Association – Medical Student Curriculum – Urinary Incontinence|publisher=American Urological Association|access-date=12 August 2015|archive-date=9 July 2015|archive-url=https://web.archive.org/web/20150709153620/http://www.auanet.org/education/urinary-incontinence.cfm|url-status=dead}}</ref><ref>{{cite web |url=http://www.turkishjournalpediatrics.org/?fullTextId=481&lang=eng |title=Acute urinary retention due to pseudoephedrine hydrochloride in a 3-year-old child |publisher=The Turkish Journal of Pediatrics |access-date=12 August 2015 |archive-date=14 August 2016 |archive-url=https://web.archive.org/web/20160814231751/http://www.turkishjournalpediatrics.org/?fullTextId=481&lang=eng |url-status=live }}</ref> According to one study, pseudoephedrine may show effectiveness as an [[antitussive]] drug (suppression of [[Cough medicine|cough]]).<ref>{{cite journal | vauthors = Minamizawa K, Goto H, Ohi Y, Shimada Y, Terasawa K, Haji A | title = Effect of d-pseudoephedrine on cough reflex and its mode of action in guinea pigs | journal = Journal of Pharmacological Sciences | volume = 102 | issue = 1 | pages = 136–142 | date = September 2006 | pmid = 16974066 | doi = 10.1254/jphs.FP0060526 | doi-access = free | title-link = doi }}</ref>

Pseudoephedrine is [[indicated]] for the treatment of nasal congestion, sinus congestion, and Eustachian tube congestion.<ref name="Bicopoulos">{{cite book | veditors = Bicopoulos D | title = AusDI: Drug information for the healthcare professional | edition = 2nd | location = Castle Hill | publisher = Pharmaceutical Care Information Services | date = 2002 }}</ref> Pseudoephedrine is also indicated for [[vasomotor rhinitis]] and as an adjunct to other agents in the optimum treatment of [[allergic rhinitis]], [[croup]], [[sinusitis]], [[otitis media]], and [[tracheobronchitis]].<ref name="Bicopoulos" />

===Other uses===
[[Amphetamine-type stimulant]]s and other [[catecholaminergic]] agents are known to have [[wakefulness-promoting agent|wakefulness-promoting effect]]s and are used in the treatment of [[hypersomnia]] and [[narcolepsy]].<ref name="SakaiChikahisaNishino2010">{{cite journal | vauthors =Sakai N, Chikahisa S, Nishino S | title=Stimulants in Excessive Daytime Sleepiness | journal=Sleep Medicine Clinics | volume=5 | issue=4 | date=2010 | doi=10.1016/j.jsmc.2010.08.009 | pages=591–607}}</ref><ref name="TakenoshitaNishino2020">{{cite journal | vauthors = Takenoshita S, Nishino S | title = Pharmacologic Management of Excessive Daytime Sleepiness | journal = Sleep Med Clin | volume = 15 | issue = 2 | pages = 177–194 | date = June 2020 | pmid = 32386693 | doi = 10.1016/j.jsmc.2020.02.006 | url = }}</ref><ref name="BoutrelKoob2004">{{cite journal | vauthors = Boutrel B, Koob GF | title = What keeps us awake: the neuropharmacology of stimulants and wakefulness-promoting medications | journal = Sleep | volume = 27 | issue = 6 | pages = 1181–1194 | date = September 2004 | pmid = 15532213 | doi = 10.1093/sleep/27.6.1181 | url = }}</ref> Pseudoephedrine at therapeutic doses does not appear to improve or worsen daytime [[sleepiness]], daytime [[fatigue (medical)|fatigue]], or [[sleep quality]] in people with [[allergic rhinitis]].<ref name="GłowackaWiela-Hojeńska2021" /><ref name="SherkatSardanaSafaee2011">{{cite journal | vauthors = Sherkat AA, Sardana N, Safaee S, Lehman EB, Craig TJ | title = The role of pseudoephedrine on daytime somnolence in patients suffering from perennial allergic rhinitis (PAR) | journal = Ann Allergy Asthma Immunol | volume = 106 | issue = 2 | pages = 97–102 | date = February 2011 | pmid = 21277510 | doi = 10.1016/j.anai.2010.11.013 | url = }}</ref> Likewise, [[somnolence]] was not lower in children with the [[common cold]] treated with pseudoephedrine for nasal congestion.<ref name="GelotteAlbrechtHynson2019">{{cite journal | vauthors = Gelotte CK, Albrecht HH, Hynson J, Gallagher V | title = A Multicenter, Randomized, Placebo-Controlled Study of Pseudoephedrine for the Temporary Relief of Nasal Congestion in Children With the Common Cold | journal = J Clin Pharmacol | volume = 59 | issue = 12 | pages = 1573–1583 | date = December 2019 | pmid = 31274197 | pmc = 6851811 | doi = 10.1002/jcph.1472 | url = }}</ref> In any case, [[insomnia]] is a known [[side effect]] of pseudoephedrine, although the incidence is low.<ref name="TavernerLatte2007" /> In addition, doses of pseudoephedrine above the normal therapeutic range have been reported to produce [[psychostimulant|stimulant]] effects including insomnia and fatigue resistance.<ref name="SchifanoChiappiniMiuli2021" />

There has been interest in pseudoephedrine as an [[appetite suppressant]] for the treatment of [[obesity]].<ref name="MunafòFraraPerico2021">{{cite journal | vauthors = Munafò A, Frara S, Perico N, Di Mauro R, Cortinovis M, Burgaletto C, Cantarella G, Remuzzi G, Giustina A, Bernardini R | title = In search of an ideal drug for safer treatment of obesity: The false promise of pseudoephedrine | journal = Rev Endocr Metab Disord | volume = 22 | issue = 4 | pages = 1013–1025 | date = December 2021 | pmid = 33945051 | pmc = 8724077 | doi = 10.1007/s11154-021-09658-w | url = }}</ref> However, due to lack of clinical data and potential cardiovascular side effects, this use is not recommended.<ref name="MunafòFraraPerico2021" /> Only a single [[placebo]]-[[controlled trial|controlled]] study of pseudoephedrine for [[weight loss]] exists (120{{nbsp}}mg/day [[slow-release]] for 12{{nbsp}}weeks) and found no significant difference in weight lost compared to placebo (-4.6{{nbsp}}kg vs. -4.5{{nbsp}}kg).<ref name="MunafòFraraPerico2021" /><ref name="GreenwayHerberRaum1999">{{cite journal | vauthors = Greenway F, Herber D, Raum W, Herber D, Morales S | title = Double-blind, randomized, placebo-controlled clinical trials with non-prescription medications for the treatment of obesity | journal = Obes Res | volume = 7 | issue = 4 | pages = 370–378 | date = July 1999 | pmid = 10440593 | doi = 10.1002/j.1550-8528.1999.tb00420.x | url = }}</ref> This was in contrast to [[phenylpropanolamine]], which has been found to be more effective at promoting weight loss compared to placebo and has been more widely studied and used in the treatment of obesity.<ref name="CoulterRebelloGreenway2018">{{cite journal | vauthors = Coulter AA, Rebello CJ, Greenway FL | title = Centrally Acting Agents for Obesity: Past, Present, and Future | journal = Drugs | volume = 78 | issue = 11 | pages = 1113–1132 | date = July 2018 | pmid = 30014268 | pmc = 6095132 | doi = 10.1007/s40265-018-0946-y | url = }}</ref><ref name="Ioannides-DemosProiettoMcNeil2005">{{cite journal | vauthors = Ioannides-Demos LL, Proietto J, McNeil JJ | title = Pharmacotherapy for obesity | journal = Drugs | volume = 65 | issue = 10 | pages = 1391–418 | date = 2005 | pmid = 15977970 | doi = 10.2165/00003495-200565100-00006 | url = }}</ref><ref name="GreenwayHerberRaum1999" />

Pseudoephedrine has been used limitedly in the treatment of [[orthostatic intolerance]] including [[orthostatic hypotension]]<ref name="FreemanKaufmann2007">{{cite journal | vauthors = Freeman R, Kaufmann H | title=Disorders of Orthostatic Tolerance—Orthostatic Hypotension, Postural Tachycardia Syndrome, and Syncope | journal=Continuum: Lifelong Learning in Neurology | volume=13 | date=2007 | issn=1080-2371 | doi=10.1212/01.CON.0000299966.05395.6c | pages=50–88}}</ref> and [[postural orthostatic tachycardia syndrome]] (POTS).<ref name="Fedorowski2019">{{cite journal | vauthors = Fedorowski A | title = Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management | journal = J Intern Med | volume = 285 | issue = 4 | pages = 352–366 | date = April 2019 | pmid = 30372565 | doi = 10.1111/joim.12852 | url = }}</ref><ref name="FedorowskiMelander2013">{{cite journal | vauthors = Fedorowski A, Melander O | title = Syndromes of orthostatic intolerance: a hidden danger | journal = J Intern Med | volume = 273 | issue = 4 | pages = 322–335 | date = April 2013 | pmid = 23216860 | doi = 10.1111/joim.12021 | url = }}</ref><ref name="AbedBallWang2012">{{cite journal | vauthors = Abed H, Ball PA, Wang LX | title = Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review | journal = J Geriatr Cardiol | volume = 9 | issue = 1 | pages = 61–67 | date = March 2012 | pmid = 22783324 | pmc = 3390096 | doi = 10.3724/SP.J.1263.2012.00061 | url = }}</ref> However, its effectiveness in the treatment of POTS is controversial.<ref name="Fedorowski2019" /><ref name="FedorowskiMelander2013" /> Pseudoephedrine has also been used limitedly in the treatment of refractory [[hypotension]] in [[intensive care unit]]s.<ref name="VanBerkelFuller2015">{{cite journal | vauthors = Van Berkel MA, Fuller LA, Alexandrov AW, Jones GM | title = Methylene blue, midodrine, and pseudoephedrine: a review of alternative agents for refractory hypotension in the intensive care unit | journal = Crit Care Nurs Q | volume = 38 | issue = 4 | pages = 345–358 | date = 2015 | pmid = 26335214 | doi = 10.1097/CNQ.0000000000000086 | url = }}</ref> However, data on this use are limited to [[case report]]s and [[case series]].<ref name="VanBerkelFuller2015" />

Pseudoephedrine is also used as a first-line prophylactic for recurrent [[priapism]].<ref name="MuneerMinhasArya2008">{{cite journal | vauthors = Muneer A, Minhas S, Arya M, Ralph DJ | title = Stuttering priapism--a review of the therapeutic options | journal = Int J Clin Pract | volume = 62 | issue = 8 | pages = 1265–1270 | date = August 2008 | pmid = 18479367 | doi = 10.1111/j.1742-1241.2008.01780.x | url = | doi-access = free }}</ref> [[Erection]] is largely a [[parasympathetic nervous system|parasympathetic]] response, so the sympathetic action of pseudoephedrine may serve to relieve this condition. Data for this use are however [[anecdotal]] and effectiveness has been described as variable.<ref name="MuneerMinhasArya2008" />

Treatment of [[urinary incontinence]] is an [[off-label use]] for pseudoephedrine and related medications.<ref>{{cite journal |url=https://www.aafp.org/pubs/afp/issues/2005/0115/p315.html |title=Selecting Medications for the Treatment of Urinary Incontinence – January 15, 2005 – American Family Physician |journal=American Family Physician |volume=71 |issue=2 |pages=315–322 |access-date=6 May 2012 |date=15 January 2005 |vauthors=Weiss BD |archive-date=7 July 2022 |archive-url=https://web.archive.org/web/20220707101320/https://www.aafp.org/pubs/afp/issues/2005/0115/p315.html |url-status=live }}</ref><ref>{{cite journal | vauthors = Culligan PJ, Heit M | title = Urinary incontinence in women: evaluation and management | journal = American Family Physician | volume = 62 | issue = 11 | pages = 2433–44, 2447, 2452 | date = December 2000 | pmid = 11130230 | url = https://www.aafp.org/pubs/afp/issues/2019/0915/p339.html | access-date = 7 September 2023 | archive-date = 7 September 2023 | archive-url = https://web.archive.org/web/20230907050537/https://www.aafp.org/pubs/afp/issues/2019/0915/p339.html | url-status = live }}</ref>

===Available forms===
{{See also|Azatadine/pseudoephedrine|Carbinoxamine/pseudoephedrine|Cetirizine/pseudoephedrine|Dexbrompheniramine/pseudoephedrine|Fexofenadine/pseudoephedrine|Pseudoephedrine/loratadine|Naproxen/pseudoephedrine}}

Pseudoephedrine is available by itself [[over-the-counter drug|over-the-counter]] in the form of 30 and 60{{nbsp}}mg [[immediate-release]] and 120 and 240{{nbsp}}mg [[extended-release]] [[oral administration|oral]] [[tablet (pharmacy)|tablet]]s in the [[United States]].<ref name="Drugs@FDA">{{cite web | title=Drugs@FDA: FDA-Approved Drugs | publisher = Food and Drug Administration | website=accessdata.fda.gov | url=https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm | access-date=14 July 2024}}</ref><ref name="KiziorHodgson2014">{{cite book | vauthors = Kizior R, Hodgson BB | title=Saunders Nursing Drug Handbook 2015 - E-Book: Saunders Nursing Drug Handbook 2015 - E-Book | publisher=Elsevier Health Sciences | year=2014 | isbn=978-0-323-28018-1 | url=https://books.google.com/books?id=qVRTBAAAQBAJ&pg=PA1016 | access-date=14 July 2024 | page=1016}}</ref><ref name="Braun2012">{{cite book | vauthors = Braun DD | title=Over the Counter Pharmaceutical Formulations | publisher=Elsevier Science | year=2012 | isbn=978-0-8155-1849-5 | url=https://books.google.com/books?id=gLjegID0K7wC&pg=PA181 | access-date=26 July 2024 | page=181}}</ref><ref name="Berry2001">{{cite book | vauthors = Berry TM | title=Nursing Nonprescription Drug Handbook | publisher=Springhouse | series=Nursing Drug Handbook Series | year=2001 | isbn=978-1-58255-101-2 | url=https://books.google.com/books?id=LVN0sLrHB8kC&pg=PA114 | access-date=14 July 2024 | page=114}}</ref>

Pseudoephedrine is also available over-the-counter and [[prescription drug|prescription-only]] [[combination drug|in combination]] with numerous other drugs, including [[antihistamine]]s ([[acrivastine]], [[azatadine]], [[brompheniramine]], [[cetirizine]], [[chlorpheniramine]], [[clemastine]], [[desloratadine]], [[dexbrompheniramine]], [[diphenhydramine]], [[fexofenadine]], [[loratadine]], [[triprolidine]]), [[analgesic]]s ([[acetaminophen]], [[codeine]], [[hydrocodone]], [[ibuprofen]], [[naproxen]]), [[cough suppressant]]s ([[dextromethorphan]]), and [[expectorant]]s ([[guaifenesin]]).<ref name="Drugs@FDA" /><ref name="KiziorHodgson2014" />

Pseudoephedrine has been used in the form of the [[hydrochloride]] and [[sulfate]] [[salt (chemistry)|salt]]s and in a polistirex form.<ref name="Drugs@FDA" /> The drug has been used in more than 135 over-the-counter and prescription formulations.<ref name="SalernoJackson2005" /> Many prescription formulations containing pseudoephedrine have been discontinued over time.<ref name="Drugs@FDA" />