Decongestants are used for various conditions that cause nasal congestion and are often marketed for treating allergic reactions and sinusitis. Decongestions work by reducing swelling in the blood vessels of the nose, thereby opening up the airway and allowing for better breathing. You will probably know the brand Sudafed, a well-known pseudoephedrine pill brand. This is safe for many patients and is available over the counter in a variety of formulations (often combined with antihistamines, e.g. Claritin-D). However, that does not mean they are without risk. Patients should speak to their doctor before taking any decongestant. This is especially true for people with hypertension or high blood pressure, thyroid concerns, liver or kidney problems, heart problems, diabetes, and glaucoma, to name a few because pseudoephedrine can . Pregnant women and those breastfeeding should also speak to their healthcare professionals, as the safety of these products in those circumstances has not been proven.
You may be familiar with the nasal spray Afrin, which contains fast-acting oxymetazoline. It is very effective, but has significant drawbacks. If used for more than a few days, there is a distinct possibility of a rebound effect that worsens the stuffiness. Not only that, but this risk can persist (becoming “addicted” to the nasal spray and requiring it more frequently to avoid rebound congestion). This is NOT true of the allergy sprays (Flonase, Astelin, Nasacort etc). Patients should read the warning labels on the packages carefully and speak to an experienced ENT like Dr. Boger to understand more. Patients should also be aware of interactions with other drugs, like anti-depressants and other all-in-one medications that include a decongestant and can cause an overdose. There is a relatively long list of possible side effects and adverse events, which will be discussed in detail on the paperwork with the product.
Dr. Boger notes that while the effects of these decongestants can be dramatic and rapid, something with such excellent results often comes with significant drawbacks. In other words, this is not a free lunch. There is a substantial risk of decongestant abuse if patients do not follow directions carefully. Many will start with a spray every eight hours, for example, but will need it more and more often (even every 2 hours) over time. In addition to this tolerance, the mucosal membranes of the nose may begin to deteriorate as these medications restrict blood flow. Ultimately surgery to open the nasal passage can be required if the patient can’t get off the spray.
A Note on Phenylephrine
As an aside, phenylephrine, a common ingredient in over-the-counter cold and allergy medicines, has recently been designated ineffective (in tablet form) by an advisory committee to the FDA. There is some debate in the ENT community regarding this. Therefore, we suggest that patients not buy any new medicine containing this compound. The FDA may decide to reclassify phenylephrine, eventually ending its commercial sale.