What is Sudafed and what is it used for?

If you have a stuffy nose or sinus pain, finding relief from these symptoms is likely at the top of your mind. Sudafed is a popular decongestant that you may unintentionally pass up in local drugstores since it’s kept behind the pharmacy counter. This article gives an overview of Sudafed, its uses, dosages, side effects, and why it sometimes requires a prescription. 

What is Sudafed?

Sudafed (pseudoephedrine) is a medication that treats a stuffy nose, sinus pain, and sinus pressure. These symptoms are often a result of a cold or the flu, but allergies and respiratory illnesses can also cause them as well.

Sudafed is a brand-name medication that’s manufactured by McNeil Consumer Healthcare, a Johnson & Johnson company. It belongs to a class of stimulant drugs called amphetamines. Amphetamines are derived from the ephedra plant, which has been used for centuries to treat congestion, asthma, and many other ailments. 

What is Sudafed used for?

Sudafed can be used to treat symptoms of the cold and flu, allergies, hay fever, and sinusitis. It relieves sinus congestion by constricting blood vessels in the sinuses, which reduces inflammation. It’s important to know that Sudafed only treats symptoms, not the underlying health condition. 

Sudafed dosages

Sudafed (pseudoephedrine) is available for purchase behind the pharmacy counter in immediate- and extended-release tablets and as a liquid solution for children. Note: Sudafed PE (phenylephrine) is available for purchase over-the-counter in different dosages. The table below includes standard doses of Sudafed—not Sudafed PE: 

How much Sudafed should I take?
Adults (12 and older)	Children ages 6-11	Children under 6 years
2 tablets taken every 4-6 hours (maximum 8 tablets in 24 hours)	1 tablet taken every 4-6 hours (maximum 4 tablets in 24 hours)	Taken only if recommended by a doctor

These dosages may vary depending on the strength and form of Sudafed you’re taking. A medical professional can help you determine how much Sudafed you should take.   

Sudafed can start working within 30 minutes. Immediate-release forms of Sudafed can begin to wear off after four to six hours. Extended-release versions of Sudafed last longer, so you don’t have to take it as frequently. 

Warnings

Do not rely on Sudafed for long-term use. If your symptoms don’t go away after seven days of using Sudafed, a doctor can advise you on what to do next. 

Furthermore, Sudafed isn’t right for everyone. “The indications for Sudafed say that it isn’t safe for use in children under 2 years old, and should only be used with a doctor’s guidance from age 2 to 6,” says Dr. Maria Vila, DO, a medical advisor for eMediHealth. “Other patients who should not use Sudafed are pregnant women during the first trimester.” Sudafed should only be used during the second or third trimester if approved by your OB-GYN. 

Women who are breastfeeding should ask a doctor before taking Sudafed, as it passes to breast milk and may cause a decrease in milk production.

Interactions

There are also some negative drug-drug interactions to be aware of before taking Sudafed. “The final group of patients who should not use Sudafed, regardless of their age, are patients with uncontrolled high blood pressure, patients with heart disease, patients taking MAO inhibitors, and patients with angle-closure glaucoma,” Dr. Vila says.

Taking Sudafed at the same time as other medications may decrease its efficacy or worsen side effects. If you’re taking any of the following medications, you should talk to your doctor before you take Sudafed: 

• Anti-hypertensive medications
• Heart medications
• Monoamine oxidase inhibitors (MAOIs)
• Antidepressants and anxiety medications
• Some flu and cold medicines
• Natural supplements like St. John’s Wort

What are the side effects of Sudafed?

Here are some common side effects you can expect when taking Sudafed: 

• Dizziness
• Nervousness
• Headache
• Trouble sleeping
• Nausea
• Vomiting
• Weakness 
• Loss of appetite   

Sudafed may cause more serious side effects. You should seek medical attention if you experience hallucinations, chest pain, irregular heartbeats, or trouble breathing.  

Although it’s rare, Sudafed may also cause allergic reactions that can be life-threatening. Allergic reactions can cause difficulty breathing, hives, and swelling of the face, throat, or mouth. You should seek immediate medical attention if you believe you’re experiencing an allergic reaction.    

Sudafed vs. Sudafed PE

The differences between Sudafed and Sudafed PE aren’t easy for pharmacy customers to decipher. Both products treat congestion from allergies, colds, and sinus infections. They work similarly by reducing inflammation to alleviate sinus pressure. They even share similar side effects. 

The main difference between Sudafed and Sudafed PE is their active ingredients. The active ingredient in Sudafed is pseudoephedrine, whereas the active ingredient in Sudafed PE is phenylephrine. Because of this, Sudafed and Sudafed PE are available in different forms and strengths. Sudafed also lasts longer and may be more effective than Sudafed PE.

Another difference is the availability of these products. You can easily find and purchase Sudafed PE and other products containing phenylephrine over the counter. However, in 2005, the Food and Drug Administration (FDA) banned over-the-counter (OTC) sales of cold medicine containing pseudoephedrine with the Combat Methamphetamine Epidemic Act. Medications like Sudafed now have to be kept behind the pharmacy counter and may require a prescription to purchase.

By making stores keep it behind the pharmacy counter, the FDA hopes to decrease the illegal use of pseudoephedrine to make methamphetamine (meth) and other drugs. Some states even have limits on how much medication their pharmacies can sell daily.     

You can still buy Sudafed; you’ll just have to buy it from behind the counter. Depending on the state you live in, you might also need a prescription from a doctor to buy Sudafed. If prescribed, you can find coupons for Sudafed on SingleCare.    

Recap: Sudafed vs. Sudafed PE
	Sudafed	Sudafed PE
Generic name	Pseudoephedrine	Phenylephrine
Forms	Liquid, tablets (immediate-release and  extended-release formula)	Tablets, caplets, liquid
Strengths	30 mg, 120 mg, 240 mg	10 mg
Dosage frequency	Immediate-release: every 4-6 hours Extended-release: every 12-24 hours, depending on product	Every 4 hours
OTC or prescription drug?	Kept behind the pharmacy counter. A prescription is sometimes required.	Available over the counter in pharmacy and drugstore aisles.

Are there alternatives to Sudafed?  

If you’re allergic to Sudafed or have a health condition that prevents you from taking it, there are alternative medications that can help with congestion and sinus pressure. Because these drugs are often found in combination with other drugs (and often do contain Sudafed), ask your pharmacist for help selecting an OTC medication that is appropriate for you, considering any medical conditions or other medications you take. Here’s a list of some popular Sudafed alternatives:

• Mucinex is an expectorant that helps clear mucus from the sinuses, throat, and lungs. It is available in several formulations, alone and in combination with a cough suppressant or Sudafed. Compare Sudafed and Mucinex here.  
• Benadryl is an antihistamine that can help relieve cold symptoms; however, drowsiness is a common side effect.
• Claritin primarily treats allergy symptoms, but it may alleviate some cold symptoms like runny noses. It is a less drowsy antihistamine than Benadryl.
• Zyrtec is not a decongestant, but it can alleviate allergy symptoms, like watery eyes, sneezing, and a runny nose.
• Allegra is a non-drowsy antihistamine, like Zyrtec, that treats upper respiratory allergies and allergic asthma.
• Xyzal is another non-drowsy antihistamine that treats hay fever and hives.

Aside from medications, many people use natural and home remedies to help with their sinus pressure, pain, and congestion. Running a humidifier at home can help with nasal congestion, and so can using a neti pot, which uses a saline solution to clear sinuses. Even staying hydrated can thin the mucus that’s produced by nasal passages.