OTC spotlight: pseudoephedrine decongestants at the counter

Why this matters

Pseudoephedrine is one of the most requested Pharmacy (P) medicines in cold and flu season. It works well for a blocked nose, but it is not suitable for everyone, there are legal limits on how much can be sold, and the MHRA has warned about very rare but serious side effects.

What support staff need to know

• It is a P medicine. Sales happen under the supervision of a pharmacist and follow your sales of medicines protocol.
• It is unlawful to sell or supply more than 720 mg of pseudoephedrine, or more than 180 mg of ephedrine, in one transaction without a prescription. Products containing pseudoephedrine and ephedrine must not be sold together.
• The limits exist because these medicines can be misused to make illegal drugs. Repeated or large requests are referred to the pharmacist every time.
• Most tablet products are for adults and children aged 12 and over. Always check the pack for the product in your hand.

WWHAM in practice

Who is it for, and how old are they? What are the symptoms? How long have they had them? Action already taken? Medicines they take for anything else?

The medicines question matters most here. Refer to the pharmacist if the person has high blood pressure, heart disease, diabetes, an overactive thyroid, glaucoma, prostate problems or kidney disease, is pregnant or breastfeeding, or takes an antidepressant, especially a monoamine oxidase inhibitor.

The MHRA safety warning

In February 2024 the MHRA reported very rare cases of two conditions affecting blood vessels in the brain in people taking pseudoephedrine: posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS).

What to tell customers: stop taking the medicine and get urgent medical help if you develop a sudden severe headache, feel or are sick, become confused, have a seizure or notice changes in your vision. The medicine should not be taken by people with very high or uncontrolled blood pressure or severe kidney disease.

When to refer to the pharmacist

• Any of the conditions or medicines listed above
• Symptoms lasting more than about a week, or getting worse
• A request for more than one pack, frequent repeat requests, or a request for the largest pack by name with no symptoms described
• Children under the age on the pack
• Any of the warning symptoms described by the MHRA

PPets learning connection

This spotlight supports the WWHAM and red flags learning in the Level 2 Certificate, and links to our free WWHAM cheat sheet and OTC red flags guide.

Record this as CPD

Registered pharmacy technicians can use this article towards GPhC revalidation, as an unplanned CPD entry or as the starting point for a reflective account. Pharmacy assistants and trainees can use it as evidence of reflective practice. Note down three things:

1. What you learned from this article
2. How you have applied it, or will apply it, in your own role
3. The benefit to the people who use your pharmacy's services

Sources and further reading

• MHRA Drug Safety Update
• Electronic medicines compendium (product SmPCs)
• NHS: pseudoephedrine

Related from PPets

• WWHAM training
• Community pharmacy red flags
• Level 2 Certificate for pharmacy support staff

This article is for general educational purposes only. It is not legal advice, professional regulatory advice or clinical advice about an individual patient. Always follow your pharmacy's SOPs and check current official guidance and product information.

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