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Decongestants relieve nasal and sinus congestion (stuffy nose) caused by allergies or colds. These drugs shrink the tissues and blood vessels in the eyes and nose that swell in response to a cold or contact with an allergen (substance that causes an allergic reaction).
These medicines do not cure colds or reverse the effects of chemicals in the body that cause allergies. Instead, they relieve symptoms of congestion (stuffiness).
Most decongestants are available over-the-counter. These drugs can be taken orally or administered through the nose in nasal sprays.
Many oral decongestants contain pseudoephedrine (like Sudafed© or Actifed©), sometimes in combination with another drug. For instance, Claritin-D© is a combination of pseudoephedrine with an antihistamine.
Decongestants are also available as nasal sprays. The medication is squirted into the nose as the patient inhales to help promote nasal drainage and relieve stuffiness.
In 2000, the U.S. Food and Drug Administration (FDA) banned over-the-counter sales of medicines containing the decongestant phenylpropanolamine. The medicine was an ingredient in many cold remedies. However, it is associated with an increased risk of stroke in people ages 18 to 49, especially women. Over-the-counter remedies containing phenylpropanolamine should be discarded.
Pseudoephedrine, once a common ingredient in over-the-counter decongestants, is only available behind-the-counter after talking with a pharmacist in many states. This is because there have been an increasing number of reports of people using pseudoephedrine to make illicit methamphetamine. Several states, including Alabama, California, Colorado, Connecticut, Delaware, Georgia, Florida, Illinois, Indiana, Iowa,
Kansas, Massachusetts, Minnesota, Missouri, Montana, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, and Washington have laws that require pharmacies to only sell pseudoephedrine behind-the-counter, and they must also record personal information about the consumer. In July 2006, Oregon passed a law that recognizes pseudoephedrine and all products containing pseudoephedrine as a Schedule III controlled substance. Therefore, consumers in Oregon need a prescription to purchase products containing pseudoephedrine.
As a result, an increasing number of manufacturers are beginning to use phenylephrine as an alternative to pseudoephedrine in their over-the-counter preparations.
Decongestants are sold in many forms, including tablets, capsules, caplets, gelcaps, liquid-caps, liquids, nasal sprays, and nose drops. Since nasal congestion (stuffy nose) is just one of many symptoms commonly associated with colds or allergies, these drugs are also sold in combination with other medicines. While most decongestants are available over-the-counter, some are only available by prescription.
Commonly used over-the-counter decongestants include oxymetazoline (like Afrin©), phenylephrine (SudafedPE©), and pseudoephedrine (like Sudafed© or Actifed©). Some states only sell pseudoephedrine-containing products behind-the-counter or by prescription. Some decongestants, including oxymetazoline and naphazoline, are also used in some eye drops in combination with antihistamines to relieve redness and swelling.
Commonly prescribed nasal decongestants include loratadine/pseudoephedrine (Claritin-D©), fexofenadine/pseudoephedrine (Allegra-D©), desloratadine/pseudoephedrine (Clarinex-D©), and cetirizine/pseudoephedrine (Zyrtec-D©). These drugs, which are combinations of decongestants and antihistamines, are typically taken once or twice a day to relieve nasal congestion associated with allergies.
The recommended dosage depends on the drug and severity of the symptoms. Patients should check with their pharmacists or healthcare providers to determine the correct dosage. Decongestants should always be taken exactly as directed.
General: Decongestants are generally considered safe for healthy adults who only take the medication when needed. Side effects are most often seen in patients with health problems that increase the likelihood and severity of side effects or in patients who take decongestants for long periods of time. Common side effects may include nervousness, dizziness, and palpitations (rapid heart beat).
Oral: The most common side effects of oral decongestants include nervousness, restlessness, excitability, dizziness, drowsiness, headache, nausea, weakness, and trouble sleeping. Patients who experience such symptoms should stop taking the medications. Patients who experience increased blood pressure, fast or irregular heartbeat, severe headache, tightness or discomfort in the chest, breathing problems, fear or anxiety, hallucinations, trembling or shaking, convulsions (seizures), pale skin, or painful or difficult urination should consult their healthcare providers immediately.
Nasal sprays: Common side effects from nasal sprays and nose drops include sneezing and temporary burning, stinging, local irritation, or dryness of the nose or throat. These effects are usually temporary and do not need medical attention. Patients who experience increased blood pressure, headache, irregular heartbeat, nervousness, dizziness, nausea, and sleep problems should consult their healthcare providers immediately.
Nasal spray decongestants like oxymetazoline (Afrin©) should not be used more than twice daily for three consecutive days because rebound nasal congestion (significant return of stuffy nose) may occur.
General: Patients should tell their healthcare providers if they are taking any drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment.
Asthma medicines: Individuals who are taking asthma medication should only take decongestants under the supervision of their healthcare providers. Decongestants are more likely to cause breathing problems in patients taking these medicines.
Caffeine: If caffeine (in beverages like coffee or tea) is taken with pseudoephedrine, it may increase the chance of side effects such as difficultly sleeping or restlessness.
Diet pills: Individuals who are taking any type of diet pills, including sibutramine (Meridia©), orlistat (Xenical©), phentermine (Adipex-P©), or Ionamin (Fastin©), should not take decongestants.
Insulin: Decongestants may increase blood sugar in people with diabetes. Therefore, patients taking insulin should not take decongestants.
Medicines that lower blood pressure: Decongestants may increase blood pressure and should not be taken with medication that lowers blood pressure.
Monoamine oxidase inhibitors (MAOIs): Decongestants may interact with monoamine oxidase inhibitors (MAOIs) like phenzeline (Nardil©) or tranylcypromine (Parnate©). MAOIs are used to treat conditions like depression and Parkinson's disease. Patients should not take decongestants at the same time as MAOIs or within two weeks of stopping treatment with MAOIs, unless their healthcare providers approve.
Seizure disorder drugs: Decongestants may increase the chance of seizures. Individuals who have a history of seizures or who are taking seizure medications should not take decongestants.
Decongestants can increase blood sugar in diabetics. They may also increase blood pressure. Therefore, decongestants are not recommended in patients with diabetes or high blood pressure.
Patients with kidney disease, seizure disorders, asthma, glaucoma, thyroid disease, diabetes or trouble urinating from an enlarged prostate should not take decongestants. These drugs may aggravate their medical condition or interact with other medications they are taking.
Patients who are pregnant or are considering becoming pregnant should consult their healthcare providers before taking decongestants. Some animal studies have suggested that decongestants may have unwanted effects on fetuses. Currently, it is unknown whether these effects also occur in humans.
Some decongestants can pass into breast milk and may cause unwanted effects in nursing babies whose mothers take the drugs. Therefore, women who are breastfeeding should consult their healthcare providers before taking decongestants.
Children may be more sensitive to side effects than adults. Individuals should check the package label carefully before giving to children.
In general, elderly patients may be more sensitive to side effects of decongestants than younger adults. Older adults should not take long-acting (extended release) decongestants. Instead, patients should take a short-acting form.
: Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form). The available studies have been of poor quality and have used combination therapies or 1,8-cineole (eucalyptol), which is a component of eucalyptus. Further studies are needed before any recommendation can be made.
Essential oils should be administered in a carrier oil to avoid toxicity. Avoid if history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
: Although commonly used in non-prescription products, there is inconclusive scientific study of eucalyptus oil or eucalyptol. Better research is necessary before a recommendation can be made.
Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use cautiously if driving or operating machinery. Avoid with history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
: Menthol, a constituent of peppermint oil, is sometimes included in inhaled preparations for nasal congestion, including "rubs" that are applied to the skin and inhaled. High-quality research is lacking in this area.
Avoid if allergic or hypersensitive to peppermint or menthol. Peppermint is generally considered safe in non-allergic adults when taken in small doses. Use cautiously with G6PD deficiency or gallbladder disease. Menthol, which makes up part of peppermint oil, is generally considered safe in non-allergic adults. But, doses of menthol greater than 1 gram per kilogram of body weight may be deadly in humans. Avoid if pregnant or breastfeeding.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- Bradley JG, Kallail KJ, Dorsch JN, et al. The effects of pseudoephedrine on blood pressure in patients with controlled, uncomplicated hypertension: a randomized, double-blind, placebo-controlled trial. J Am Board Fam Pract. 1991 Jul-Aug;4(4):201-6. .View abstract
- Henderson, Charles W. "Voluntary Withdrawal of Cold and Allergy Products Announced." Medical Letter on the CDC and FDA, November 26, 2000.
- Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2007. Accessed April 20, 2007.
- Simasek M, Blandino DA. Treatment of the common cold. Am Fam Physician. 2007 Feb 15;75(4):515-20. .View abstract
- U.S. Food and Drug Administration (FDA). www.fda.gov. Accessed April 20, 2007.
- U.S. Pharmacist. www.uspharmacist.com. Accessed April 20, 2007.
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