Pseudoephedrine

The Basics

What is Pseudoephedrine?

May be used as a nasal/sinus decongestant, as a stimulant, or, in higher doses, as a wakefulness-promoting agent.

Brand names for Pseudoephedrine

Sudafed

How Pseudoephedrine is classified

Adrenergic Agents, Adrenergic Alpha-Agonists, Central Nervous System Stimulants, Sympathomimetics, Vasoconstrictor Agents

Pseudoephedrine During Pregnancy

Pseudoephedrine pregnancy category

Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Pseudoephedrine while pregnant

Can you take pseudoephedrine while pregnant? The American College of Obstetricians and Gynecologists (ACOG) and the American College of Allergy, Asthma and Immunology (ACAAI) recommend using pseudoephedrine during pregnancy but not in the first trimester, and only at low doses. In general, they advise against the use of oral decongestants during the first trimester because of the potential increased risk of gastroschisis (an abdominal wall defect). Pseudoephedrine may activate alpha-adrenergic receptors, elevating blood pressure or causing vasoconstriction in the uterine arteries, and potentially adversely affecting blood flow to the fetus. This process could explain the reported association between the use of pseudoephedrine in the first trimester and the development of gastroschisis.9 This theory is debatable; evidence suggests that this effect is negligible at typical dosages.

Taking Pseudoephedrine While Breastfeeding

What are recommendations for lactation if you're taking Pseudoephedrine?

Although the small amounts of pseudoephedrine in breastmilk are unlikely to harm the nursing infant, it may cause irritability occasionally. A single dose of pseudoephedrine decreases milk production acutely and repeated use seems to interfere with lactation. Mothers with newborns whose lactation is not yet well established or in mothers who are having difficulties producing sufficient milk should not receive pseudoephedrine. A treatment scheme has been reported for mothers with hypergalactia that uses pseudoephedrine to decrease milk supply.[1]

Maternal / infant drug levels

Although the small amounts of pseudoephedrine in breastmilk are unlikely to harm the nursing infant, it may cause irritability occasionally. A single dose of pseudoephedrine decreases milk production acutely and repeated use seems to interfere with lactation. Mothers with newborns whose lactation is not yet well established or in mothers who are having difficulties producing sufficient milk should not receive pseudoephedrine. A treatment scheme has been reported for mothers with hypergalactia that uses pseudoephedrine to decrease milk supply.[1]

Possible effects of Pseudoephedrine on milk supply

After a single dose of pseudoephedrine 60 mg orally in 8 nursing mothers, there was a mean 24% decrease in milk production over the following 24 hours. No change in blood flow to the breast was detected that could explain the decreased milk production; there was a 13.5% decrease in serum prolactin after pseudoephedrine, but this change did not achieve statistical significance. Oxytocin levels were not measured.[3]

Possible alternatives to Pseudoephedrine

Oxymetazoline.