Sudafed vs. Sudafed PE: Everything You Need to Know About These Decongestants
Key takeaways:
Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine) are decongestant medications that treat nasal and sinus congestion.
Sudafed is generally more effective at relieving nasal and sinus congestion than Sudafed PE. But it has more risks.
Sudafed has some purchase restrictions, so it’s only available behind the pharmacy counter. Sudafed PE is readily available over the counter on pharmacy and grocery store shelves.
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Table of contents
Sinus problems are among the most annoying symptoms of everyday illnesses and allergies. A stuffy nose and blocked ears can take the pep out of anyone’s step. Thankfully, there are several treatment options available without a prescription that can help get you back on track.
Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine) are decongestant medications that treat nasal and sinus congestion from allergies and the common cold. Sudafed is available behind the pharmacy counter, while Sudafed PE is readily available over the counter (OTC). But with such similar names, what difference do two extra letters really make?
What are the active ingredients in Sudafed and Sudafed PE?
The active ingredient in Sudafed is pseudoephedrine, a nasal decongestant. Sudafed PE is also a nasal decongestant, but it contains phenylephrine.
While these active ingredients are slightly different, they work in a similar way. Pseudoephedrine and phenylephrine both narrow blood vessels in your nose and sinuses, opening up your airways and allowing the sinuses to drain. This helps clear your nose and allows you to breathe better.
However, they’re not one and the same. Sudafed is more effective than Sudafed PE, but it has a higher risk for misuse. More on this later.
Good to know: In Sudafed PE, the “PE” stands for phenylephrine.
Which is more effective, Sudafed or Sudafed PE?
Experts agree that Sudafed is more effective for congestion than Sudafed PE.
In 2023, an FDA expert committee took a closer look at recent evidence for oral phenylephrine. They found that even though it is not dangerous to take, Sudafed PE is not effective for nasal congestion.
This effectiveness gap is likely due to the fact that the intestines only absorb about 38% of Sudafed PE doses. On the other hand, Sudafed is about 100% absorbed. Meaning, more Sudafed travels from your gut into your bloodstream, allowing it to get where it needs to go to relieve your congestion.
Pseudoephedrine’s effects also tend to last a bit longer. You can take Sudafed every 4 to 6 hours as needed, while Sudafed PE can be taken as often as every 4 hours.
Importantly, this does not apply to phenylephrine nasal spray (Neo-Synephrine). This form of phenylephrine is sprayed in the nose and works quickly to treat clogged sinuses.
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What dosage forms and doses are Sudafed and Sudafed PE available in?
Sudafed is available as immediate-release (IR) and extended-release (ER) pseudoephedrine tablets. ER medications last longer and are taken less frequently than IR medications.
Sudafed IR comes as 30 mg and 60 mg tablets. It can be taken by people ages 6 years and older. The ER tablets come in higher doses (120 mg and 240 mg), but they’re only meant for people ages 12 years and older. It’s less common, but a Sudafed 15 mg/5 mL oral liquid is also available for kids ages 4 years and older.
Sudafed PE is available as an oral form for adults and children ages 4 years and older. Phenylephrine comes as a 10 mg tablet and a 2.5 mg/5 mL liquid.
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Both ingredients are also available in combination with other medications. For example, pseudoephedrine is often found in allergy-relief products like Claritin-D (loratadine / pseudoephedrine).
Sudafed and Sudafed PE both also have several branded combination products, such as Sudafed Sinus 12 Hour Pressure + Pain (pseudoephedrine / naproxen) and Sudafed PE Head Congestion + Flu Severe (phenylephrine / acetaminophen / dextromethorphan / guaifenesin).
Note: Phenylephrine is available as an OTC nasal spray and prescription-only eye drop too, but it’s not branded as Sudafed PE.
What are the recommended dosages of Sudafed and Sudafed PE?
Recommended Sudafed and Sudafed PE dosages vary depending on the formulation and who’s taking it. Here’s a quick summary.
Age range | ||
Younger than 4 years old | Not recommended | Not recommended |
4-5 years old | Liquid: 5 mL every 4-6 hours as needed | Liquid: 5 mL every 4 hours as needed |
6-11 years old | Liquid: 10 mL every 4-6 hours as needed IR tablet: 30 mg every 4-6 hours as needed ER tablet: Not recommended | Liquid: 10 mL every 4 hours as needed Tablet: Ask a healthcare professional |
12 years and older | IR tablet: 60 mg every 4-6 hours as needed ER tablet: 120 mg twice daily as needed OR 240 mg once daily as needed | Tablets: 10 mg every 4 hours as needed |
Keep in mind: These are recommended dosages for most people. Everyone is unique — especially kids — so make sure to ask your healthcare professional about how much is appropriate for you or your child.
What are the side effects of Sudafed vs. Sudafed PE?
When taken as directed, Sudafed side effects and Sudafed PE side effects are similar. They’re generally well-tolerated, but some of the most common side effects include:
Trouble sleeping
Restlessness
Nervousness
Dizziness
Headache
Nausea
Upset stomach
Loss of appetite
Lightheadedness
High blood pressure and an increased heart rate are also possible with both medications. Because of these risks, Sudafed and Sudafed PE aren’t the best options if you have high blood pressure, diabetes, or heart problems.
If you experience significant blood pressure or heart rate changes while taking Sudafed or Sudafed PE, contact your healthcare professional immediately.
Can you take Sudafed and Sudafed PE during pregnancy?
It’s a good idea to avoid Sudafed and Sudafed PE during pregnancy — especially the first trimester.
Taking oral decongestants like these during the first trimester can increase the risk of birth defects for your baby. This is because oral decongestants tighten blood vessels, reducing blood flow to the fetus. The American College of Obstetricians and Gynecologists recommends avoiding oral decongestants in the first trimester. The safety of pseudoephedrine and phenylephrine during the second and third trimester of pregnancy hasn’t been established.
If you or a loved one are pregnant, speak with your prenatal care team about the risks and benefits of taking Sudafed or Sudafed PE. If you have nasal congestion and want a more conservative option, they can also talk to you about alternative medications to treat your symptoms.
How do you get Sudafed and Sudafed PE at the pharmacy?
Sudafed PE and other phenylephrine-containing products are readily available in the aisles of your local pharmacy or grocery store. There aren’t any federal- or state-mandated restrictions for purchasing phenylephrine.
Sudafed and other pseudoephedrine-containing products, by comparison, have restrictions. They have a risk for misuse. Pseudoepherine has been used illegally to make methamphetamine, a type of street drug.
As a precaution, pseudoephedrine needs to be purchased at the pharmacy counter. There’s also a limit on how much can be purchased at a time. Federal law limits sales to 3.6 grams per day and no more than 9 grams in a 30-day period. You will also be asked to present a photo ID and offer your written signature before purchasing it due to the Combat Methamphetamine Epidemic Act.
Your state may have additional restrictions for purchasing Sufafed. Your pharmacist is a great resource to ask about Sudafed restrictions where you live.
The bottom line
The medication in Sudafed is pseudoephedrine and in Sudafed PE it’s phenylephrine. Both are oral decongestants that treat nasal and sinus congestion. Sudafed is available for purchase behind the pharmacy counter, while Sudafed PE is available over the counter (OTC) like a standard product. Sudafed is more effective, but both medications cause similar side effects. If you’re pregnant or have health conditions like high blood pressure, it’s important to speak with your healthcare professional about the risks and benefits before trying either one.
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References
American College of Obstetricians and Gynecologists. (2021). What medicine can I take for allergies while I'm pregnant?
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Johnson and Johnson Consumer Inc. (2024). Sudafed PE head congestion plus flu severe - acetaminophen, dextromethorphan hydrobromide, guaifenesin, and phenylephrine hydrochloride tablet, film coated [package insert]. DailyMed.
Johnson and Johnson Consumer Inc. (2024). Sudafed sinus 12 hour pressure plus pain - naproxen sodium and pseudoephedrine hydrochloride tablet, multilayer, extended release [package insert]. DailyMed.
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U.S. Food and Drug Administration. (2024). Legal requirements for the sale and purchase of drug products containing pseudoephedrine, ephedrine, and phenylpropanolamine.
Yau, W. P., et al. (2013). Use of decongestants during pregnancy and the risk of birth defects. American Journal of Epidemiology.
