Sudafed: To Be or Not to Be . . . A Prescription?

Roni Shye
Roni Shye, PharmD BCGP BCACP, is a licensed pharmacist in the states of Florida, Ohio, and Pennsylvania.
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What comes to mind when you think about where to find medications for treating symptoms of a cough, the common cold, allergies, or sinus problems? Most people imagine being able to walk through the aisles of their local pharmacy or grocery store to find cough syrup, nasal decongestants, or cold tabs. However, sometimes these items are not where you would expect to find them—like behind the pharmacy counter.

Most medications that are located behind the counter in the pharmacy require a prescription from your doctor, though it isn’t always the case. There are plenty of products stocked in the pharmacy that, surprisingly, may not require a prescription depending on which state you are located in. One of those products is pseudoephedrine, also known as Sudafed. Pseudoephedrine can be found alone for nasal congestion or in a variety of combination products used for cough, cold, allergy, or sinus problems.

What is Sudafed for?
Sudafed (pseudoephedrine) is a decongestant product used to relieve stuffiness or congestion in the nasal cavity due to the common cold, allergies, hay fever, or sinusitis.

Are products containing pseudoephedrine available without a prescription?

Depending on the state you reside in, the answer can be YES or NO!

If you live in a state in which a prescription is NOT required, you must still get these products from behind the pharmacy counter. Most of the time you will need to present your photo ID and sign for your medicine in an electronic or paper log.

If you live in a state in which a prescription IS required, your doctor must provide you or your local pharmacy with a valid prescription for the medication you need.

Which states require a prescription for Sudafed or pseudoephedrine-containing products?

Currently, only Oregon and Mississippi have state-wide laws in place which require a prescription for all products containing pseudoephedrine. However, there are local laws in place in a number of cities in Missouri and Tennessee.

Which cities in Missouri require that you have a prescription?

Cities that require a prescription in Missouri include but are not limited to Arnold, Branson, Cape Girardeau, Crystal City, Doniphan, Joplin, Perryville, Licking, Jackson, and Houston.

Which cities in Tennessee require that you have a prescription?

Cities that require a prescription in Tennessee include but are not limited to Huntland, Winchester, Estill Springs, and Martin City.

Why is Sudafed so tightly regulated?
Pseudoephedrine is the main ingredient used to make methamphetamine or crystal meth, an illegal and highly addictive drug. Because meth can be easily made with pseudoephedrine and common every day household products, law makers are trying to limit the access of pseudoephedrine in order to limit the illegal production of meth.

Does Sudafed come in other forms that are not located behind the pharmacy counter?

Yes. Sudafed PE products are located in the store aisles and do not require the same strict rules and regulations as the Sudafed products located behind the pharmacy counter. The active ingredient in Sudafed PE is phenylephrine, instead of pseudoephedrine.

Which product is more effective for congestion—pseudoephedrine or phenylephrine?

Most patients and healthcare providers will agree that pseudoephedrine is more effective for congestion than its counterpart phenylephrine. This is likely due to the fact that the intestines will absorb only about 38% of the phenylephrine in one tablet, while pseudoephedrine is 100% absorbed. Also, the effects of phenylephrine do not last as long as pseudoephedrine. Therefore, phenylephrine needs to be taken every four hours, while pseudoephedrine can be taken every four to six hours.

If I have high blood pressure, can I use pseudoephedrine or phenylephrine products?

NO, I would not recommend using these products without consulting with your doctor. This medication is a vasoconstrictor, meaning that it can tighten the blood vessels. This tightening or constriction can further increase the blood pressure of someone who has already been diagnosed with hypertension, leading to an increased risk of cardiovascular events such as heart attack or stroke.

Additional Information:

Learn about some of the various Sudafed and Sudafed PE products available here. Many other combination allergy and cough and cold products also contain pseudoephedrine or phenylephrine.

Learn more about the Combat Methamphetamine Epidemic Act of 2005.

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