Pseudoephedrine vs. Phenylephrine: What’s the Difference?

You may know pseudoephedrine and phenylephrine from their use in Sudafed products. Sudafed contains pseudoephedrine, while Sudafed PE contains phenylephrine. The drugs are also available in several combinations with other over-the-counter cough and cold medications.

These drugs are both nasal decongestants. They’re used for short-term relief of congestion and pressure in the sinuses and nasal passages caused by the common cold, hay fever, or other allergies.

If you’re ready to breathe easier, check out this comparison of pseudoephedrine and phenylephrine.

The chart below is a quick snapshot of some of the basic information for pseudoephedrine and phenylephrine.

* Except for the extended-release tablets, which are only safe for children 12 years and older
** Pseudoephedrine itself is not addictive. However, the illegal methamphetamine that it can be used to make is highly addictive.

You can walk into any pharmacy and buy phenylephrine off the shelf like you would for any other purchase. But for pseudoephedrine, there are special requirements.

To get it, you have to buy it from the pharmacy staff, not off the shelf. You also have to show ID, and you’re limited in the amount you can buy daily and monthly.

The reason for these requirements is that pseudoephedrine is used to make illegal methamphetamine, which is highly addictive. These rules help prevent people from buying products that contain pseudoephedrine to make methamphetamine.

Studies in 2006 and 2009 found pseudoephedrine to be more effective than phenylephrine in the treatment of nasal congestion.

Both pseudoephedrine and phenylephrine can cause side effects. Call your doctor if you have any serious side effects when using these drugs.

The chart below lists examples of possible side effects from pseudoephedrine and phenylephrine.

In addition to these side effects, pseudoephedrine can cause increased heart rate, insomnia, and anxiety, while phenylephrine can elevate blood pressure, headache, and dizziness.

Rebound congestion (congestion that occurs from overuse of nasal decongestants) may also develop if nasal phenylephrine is used more times in one day or for more days than indicated on the label.

An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

Before starting pseudoephedrine or phenylephrine, tell your doctor about all medications, vitamins, or herbs you’re taking. This can help your doctor prevent possible interactions.

Don’t use with MAOIs

One class of drugs that is known to interact with both pseudoephedrine and phenylephrine is monoamine oxidase inhibitors (MAOIs). This class includes drugs such as:

If you’re taking an MAOI, do not take pseudoephedrine or phenylephrine. Ask your doctor about other treatment options.

Don’t use them together

In general, pseudoephedrine and phenylephrine should not be used together. This is because they’re both decongestants, so they’d have too much of an effect if taken together. Combining them could lead to increases in both blood pressure and heart rate.

However, check with your doctor. In some cases, you may be able to try pseudoephedrine two to three hours after your last dose of phenylephrine if you didn’t have symptom relief with phenylephrine.

Certain medications can make certain conditions or diseases worse. If you have any of the following conditions, you should discuss with your doctor before taking pseudoephedrine or phenylephrine:

If you want to take pseudoephedrine, you should also talk to your doctor if you have glaucoma.

Pseudoephedrine and phenylephrine are category B2 drugs, which means there is insufficient evidence of birth defects, but they are not conclusively proven safe either.

Women should avoid using these drugs during the first trimester of pregnancy and possibly throughout pregnancy.

These drugs also pass into a woman’s breast milk, though phenylephrine does so in smaller amounts. That means these drugs may have side effects in a child who is breastfed by someone who takes these drugs.

For example, pseudoephedrine may cause irritability and sleep changes in the child. In the mother, both drugs may decrease milk production.

If you’re pregnant or breastfeeding, talk with your doctor before using either of these drugs. Other treatments, such as oxymetazoline or the nasal form of phenylephrine, may be better options for you when you’re breastfeeding.

While pseudoephedrine and phenylephrine are similar in many ways, they also have some real differences. These include:

If you’re trying to decide which option might be better for you, talk with your doctor or pharmacist. They can help you determine if pseudoephedrine, phenylephrine, or another drug would be a good choice for you.