Phenylephrine vs Pseudoephedrine – Side Effects and Uses


It is the active ingredient in many generic products, including over-the-counter (OTC) drugs and children’s cough medications.

It is marketed as an alternative for other types of decongestants since it reduces the size of the blood vessels in the nose and sinuses helping the patient to breathe more easily. In addition, it may be used in ear infections to relieve congestion.

This medicine belongs to a group of drugs, named – sympathomimetic agents which work by constricting blood vessels.


It is used for the relief of stuffy nose and ear symptoms caused by flu, the common cold, allergies, bronchitis, or sinusitis.


It comes as a liquid, a tablet, or a dissolving strip to take by mouth. This medicine is commonly taken every four hours as required. Also, it is available in extended-release forms which are generally used a maximum of two times per day.

The 0.25 percent solution may be used in children six to 12 years of age. The 0.125 percent solution may be used by children 2 to 6 years of age, however, it is very important to not be used for children younger than two years of age, except if it is recommended by a healthcare professional.

Side Effects And Precautions

Frequent side effects include:

  • restlessness, nervousness, or excitability;
  • vomiting and nausea;
  • headaches;
  • dizziness;
  • tremors;
  • chest pain and breathing problems;
  • anxiety and fear;
  • convulsions and hallucinations;
  • feeling faint;
  • allergic reactions, such as – skin rash, hives or itching, swelling of the tongue, face, and lips;
  • fast, irregular heartbeat;
  • swelling inside the nose.

Note – seniors are more likely to suffer these side effects from this medicine, according to 2005 Lippincott’s Nursing Drug Guide.

This medication should be used cautiously if you are using MAO inhibitors (since they can increase blood pressure considerably), such as – phenelzine (Nardil), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan).

Pregnancy & Breastfeeding/strong>

Do not use this drug without a healthcare professional’s advice if you are breastfeeding a baby since it can pass into breast milk.

Before you use this medication, it is recommended to tell your healthcare specialist if you have heart rhythm disorder, heart disease, circulation problems, hypertension, glaucoma, type 2 diabetes mellitus, kidney disease, a thyroid disorder, anxiety, an enlarged prostate, bipolar disorder, or sleep problems.

Moreover, this drug spray bottle should not be shared with more than one person as well as it should be wiped clean after each use to avoid spreading infection.


To avoid unnecessary side effects, do not consume alcoholic drinks while taking this decongestant.

Important Note

Recent clinical trials show this medicine taken orally at the recommended dose to be just as effective as a placebo for allergy relief. More importantly, this oral decongestant is not effective at the FDA-approved amount found (that is usually found in most popular non-prescription brands), plus, this medicine may not even work at much higher doses, according to scientists at the University of Florida.


It belongs to a group of drugs, named – decongestants. It is commonly used to relieve symptoms of sinus or nasal congestion which occur with sinusitis, allergies, the common cold, and ear infections.

It actually is a drug found in a variety of behind-the-counter and prescription medications (for instance, it is a common ingredient in about 135 products), such as – Zyrtec-D, Sudafed Congestion (but not Sudafed PE), and Claritin-D.


It is used to treat sinus and nasal congestion as well as the congestion of the eustachian tubes, the tubes which drain fluid from the inner ear.

Additionally, this medicine is an essential ingredient in making methamphetamine, a semisynthetic or synthetic drug that stimulates the central nervous system with numerous immediate and long-term harmful effects.

Side Effects

Frequent side effects include:

  • restlessness and nervousness;
  • heart palpitations and pounding heartbeat;
  • painful urination;
  • insomnia;
  • increased sweating;
  • dizziness and lightheadedness;
  • headaches;
  • trembling;
  • nausea and vomiting;
  • unusual paleness;
  • troubled breathing;
  • weakness.

More importantly, it can raise blood pressure, therefore, check with your healthcare professional before using it if you have hypertension or other heart conditions.

It is also recommended to avoid caffeine-containing beverages (including – some types of tea, coffee, energy drinks, and some soft drinks) since these may notably increase insomnia and restlessness caused by this medicine in sensitive individuals.

While this medicine may be used for children as young as 6 years of age for these conditions, it is best to talk with your doctor first.

Also, it is not recommended for breastfeeding women since it reduces milk supply by about 20%.

Drug Interactions

It may interact with the following drugs:

  • methyldopa (Aldomet);
  • nortriptyline (Pamelor);
  • doxepin (Sinequan);
  • amitriptyline (Elavil);
  • Digitalis (Crystodigin);
  • mecamylamine (Inversine).


Patients can limit the development of these adverse effects by avoiding taking this drug on an empty stomach.

Bottom Line – Phenylephrine vs Pseudoephedrine

Both drugs are decongestants used to treat nasal congestion because of colds, allergies, or sinus infections.

However, a 2009 study done at the ENT University Clinic, University of Vienna, Austria, concluded that pseudoephedrine is considerably more effective than phenylephrine in the treatment of this type of problem.

Despite being a better decongestant, it is currently replaced by phenylephrine due to the fact that it is used in the illegal manufacturing of the drug – methamphetamine.

Image credit – Shutterstock

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