5.7 Decongestants

Pseudoephedrine is an Alpha-1 agonist and an over-the-counter (OTC) decongestant (see Figure 5.9^[1]). Pseudoephedrine has had recent limitations placed on its use because it is a common ingredient in the illicit manufacturing of the drug methamphetamine. Pharmacies now require individuals to provide identification to purchase pseudoephedrine and must track the number of purchases. As a result, most over-the-counter decongestants now contain phenylephrine. More details regarding pseudoephedrine are described in the “Autonomic Nervous System” chapter.

Mechanism of Action: Pseudoephedrine acts directly on the adrenergic receptors and acts indirectly by releasing norepinephrine from its storage sites. The drug produces vasoconstriction, which shrinks nasal mucosa membranes.

Indications: Decongestants relieve nasal obstruction due to inflammation.

Nursing Considerations: This medication is not safe for children under the age of 4 years.

Side Effects/Adverse Effects: Common adverse/side effects include hypertension, dysrhythmia, dizziness, headache, insomnia, and restlessness. Some clients may experience blurred vision, tinnitus, chest tightness, dry nose, and nasal congestion.

Decongestants are contraindicated in clients with severe hypertension, coronary artery disease (CAD), narrow-angle glaucoma, and some antidepressant use. Also, use with caution in clients who have cardiac dysrhythmias, hyperthyroidism, DM (diabetes mellitus), and prostatic hypertrophy.^[2]

Health Teaching & Health Promotion: Clients must take care to follow dosing recommendations. If dosing standards are surpassed, some clients may experience side effects such as increased nervousness, breathing difficulties, heart rate changes, and hallucinations.^[3]

Now let’s take a closer look at the medication grid on pseudoephedrine in Table 5.7.^[4],[5],[6]

Table 5.7 Pseudoephedrine Medication Grid