What Are Nasal Decongestants?
Over-the-counter (OTC) nasal decongestants are medications that offer temporary relief from nasal blockages. They come in the form of liquids, nasal sprays, nose drops and pills, which are all available without a required prescription.
Nose stuffiness can stem from allergies or sinus infections, which can cause the nasal lining to swell, leading to blockages. Decongestants may be effective in temporarily reducing congestion in the nose, as they are formulated to reopen the nasal passages by decreasing blood flow in the sinuses to relieve the pressure that’s causing the blockages.
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Types of Nasal Decongestants
There are different types of OTC nasal decongestants with distinct formulations. See below for the most common OTC nasal decongestant types.
Phenylephrine Decongestant
This type of OTC nasal decongestant is formulated to combat sinus congestion stemming from the cold or flu. It’s offered as a standalone medication and incorporated in multi-drug combinations. Sudafed PE is classified as phenylephrine, for example. It is meant to be taken for short-term relief, approximately every four hours.
Studies suggest that phenylephrine decongestants are no more effective than a placebo in treating nasal congestion[1]Horak F, Zieglmayer P, Zieglmayer R, et al.. A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber. Ann Allergy Asthma Immunol. 2009 ;102(2):116-20. . If you have a pre-existing health condition or are taking other prescription medications, it is recommended that you speak with a doctor before taking this type of OTC nasal decongestant. Its potential side effects range from anxiety to dizziness.
Pseudoephedrine Decongestant
Sudafed and Silfedrine both contain pseudoephedrine, a longer-acting active ingredient found in 12 and 24-hour formulations which combats sinus congestion symptoms caused by the cold or flu. Individuals can take pseudoephedrine as a standalone medication or in a multi-drug combination.
Research shows that pseudoephedrine may be more effective in reducing nasal congestion than a placebo[1]Horak F, Zieglmayer P, Zieglmayer R, et al.. A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber. Ann Allergy Asthma Immunol. 2009 ;102(2):116-20. . However, the Food and Drug Administration (FDA) enforced restrictions on the distribution of pseudoephedrine as a result of its illegal use in manufacturing methamphetamine. Thus, users must provide proof of ID upon purchase of a product containing pseudoephedrine.
Retailers are also required to restrict the amount of pseudoephedrine that they supply to a customer each month and log the quantity of pseudoephedrine that a customer purchases for a minimum of two years.
Intranasal Decongestants
Intranasal decongestants require direct application inside the nose for effective results. Overuse of these nasal sprays may cause sneezing and rebound congestion.
Intranasal Corticosteroids
This medication reduces excess mucus production and swelling in the nasal passages caused by inflammation. It’s generally safe for short-term use. However, it’s possible that you may experience nosebleeds, dryness, burning sensations and similar side effects.
Antihistamines
Antihistamines don’t technically count as a decongestant. However, taking an antihistamine may help in alleviating allergy-driven nasal congestion. Adults can safely use this medication at their discretion. However, keep in mind that excessive use could result in an overdose.
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Factors to Consider When Buying Nasal Decongestants
There are a few factors to consider when choosing an OTC nasal decongestant—the most important being your main reason for use. “There are fairly narrow circumstances under which a nasal decongestant would be recommended, and really only for very short periods of time,” says Brian Vickery, M.D., a pediatric allergist-immunologist and the chief of Allergy and Immunology at Children’s Healthcare of Atlanta.
In most cases, adults and adolescents older than 12 may consider this OTC solution for “cold and symptom relief,” he continues. In doing so, “you’d have to think carefully about which [type of decongestant] to use.” An allergist or general physician can further guide you on the OTC decongestant best tailored to your needs.
Other factors to consider are your preexisting health conditions and current medications you’re on. As an example, Dr. Vickery suggests that people with high blood pressure or heart disease should “be careful” with using OTC nasal decongestants, as “these products tend to increase vascular tone, increase heart rate [and] increase blood pressure.”
Are Nasal Decongestants Safe?
Nasal decongestants are generally safe for short-term use, but you should always consult with your doctor before using, especially if you have a preexisting health condition or are on other medications. The FDA also warns of excessively using propylhexedrine in particular, confirming that an overdose may cause heart and mental health-related harm, and could even be deadly.
Who Shouldn’t Use Nasal Decongestants?
People with high blood pressure and heart disease should always consult with a doctor before use. However, “anybody under [age] 12” should refrain from using over-the-counter nasal decongestants, cough and cold medications entirely, explains Dr. Vickery. The FDA confirms that these products could have fatal effects on young children (under age 4). Studies have also alluded to their limited effectiveness in children under age 12[2]van Driel ML, Scheire S, Deckx L, Gevaert P, De Sutter A. What treatments are effective for common cold in adults and children?. BMJ. 2018; 363 :k3786. .
Ingredients in Nasal Decongestants
The two most common ingredients in OTC nasal decongestants are pseudoephedrine and phenylephrine. Both ingredients are safe for short-term use.
Other typical ingredients include:
- Levomethamphetamine
- Propylhexedrine
- Tetrahydrozoline hydrochloride
- Oxymetazoline hydrochloride
- Naphazoline hydrochloride
- Xylometazoline hydrochloride
When Is the Best Time to Use Nasal Decongestants?
OTC nasal decongestants are formulated for short-term use and should never be taken for long periods to avoid the listed side effects below. For people planning to use a topical nasal decongestant like a spray, Dr. Vickery adds, “you really shouldn’t use it for more than about three days.” Temporary use can reduce chances of rebound congestion, he advises.
Side Effects of Nasal Decongestants
OTC nasal decongestants may cause the following side effects, according to Dr. Vickery:
- Agitation
- Jittery feelings
- Dry mouth
- Insomnia
- Rapid or irregular heartbeat
- Irritation in the nose
- Headaches
- Rash
- Rebound congestion
Side effects can be “worse with oral decongestants,” which include:
- Heart palpitations
- Headaches
- Tachycardia (rapid heartbeat)
- Irritability
- High blood pressure
Dr. Vickery further clarifies that rebound congestion happens when the body adjusts to the medication (due to long-term use), making it less effective over time and requiring users to increase the dosage for continued relief. Ceasing long-term use after your body becomes accustomed to it could lead to “a withdrawal from the medication,” triggering rebound congestion. For this reason, experts recommend limiting use to a maximum of three days.
How to Choose Nasal Decongestants
Before using a nasal decongestant, Dr. Vickery encourages consulting with a doctor. OTC nasal decongestants are “generally not recommended” and your form of nasal congestion could have a different type of treatment.
Top Nasal Decongestant Recommendations
If you’re looking for OTC nasal decongestant recommendations, Cori Passer, M.D., a board certified allergist and immunologist who practices at Allergy & Asthma Care P.A. in Overland Park, Kansas and a member of the Forbes Health Advisory Board, highlights her top picks:
Nasacort
Dr. Passer calls Nasacort “the best overall” for both adults and kids over 12 years of age (speak with a doctor before use for kids ages two to 12), noting the lack of side effects. “It will not kick in immediately but with regular use will control congestion the best,” she explains.
Astepro
“This is a new OTC med,” explains Dr. Passer. “It’s an antihistamine spray that can help with acute symptoms including congestion.” She suggests up to two sprays in each nostril daily for both kids (12 years and older) and adults.
Sudafed
Dr. Passer recommends Sudafed for adults only, but not for elderly individuals and those with hypertension. “It can be taken in four to six-hour dosing or the extended release for 12 hours,” she says, noting that it’s effective, but associated with side effects including elevated blood pressure and insomnia.
There are several OTC treatments available for nasal congestion. To ensure that you make the right treatment choice, the best option is to talk with your doctor first.
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