How To Choose An OTC Nasal Decongestant (2024)

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 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 circ*mstances 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:


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.


“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.


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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How To Choose An OTC Nasal Decongestant (2024)


How To Choose An OTC Nasal Decongestant? ›

The best way to choose a nasal decongestant is to look at the active ingredients. A good decongestant should treat only the symptoms you have, not any symptoms you don't have. OTC decongestants are not a solution for severe, long lasting sinus infections and chronic allergies.

What is the best OTC nasal decongestant? ›

Top Nasal Decongestant Recommendations
  • 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. ...
  • Astepro. “This is a new OTC med,” explains Dr. Passer. ...
  • Sudafed. Dr.
Jan 12, 2024

Which is better for sinus pressure phenylephrine or pseudoephedrine? ›

Studies have shown that pseudoephedrine is a much more effective decongestant than phenylephrine. Phenylephrine's decongestant effects may not be significantly different from that of a placebo. The effects of both drugs may be augmented with concurrent use of other products that affect rhinitis, such as antihistamines.

Should I take Sudafed or Mucinex? ›

Sudafed and Mucinex are both effective at treating different cold and allergy symptoms. If you are experiencing nasal congestion and need fast relief, Sudafed may be your better option. However, if you have chest congestion and need to loosen and thin mucus, Mucinex may be the more effective choice.

What is the safest decongestant for seniors? ›

Saline spray or a saline nasal wash

Mucus buildup in your sinus passages is never fun, and Linnebur says these remedies should be the first choice of relief for older adults.

Is Mucinex or Sudafed better for nose congestion? ›

Sudafed helps relieve a stuffy nose. Mucinex (Mucinex coupons | Mucinex details) contains an expectorant called guaifenesin. Guaifenesin helps thin and loosen up chest congestion when you have a phlegmy cough. Some formulations of Mucinex also contain other ingredients like dextromethorphan, a cough suppressant.

Is a decongestant or antihistamine better for a stuffy nose? ›

For true cold symptoms, a decongestant will provide more relief than an antihistamine. If you notice your “cold” symptoms occur at the same time each year (spring for examine), or are consistent year-round, you may actually have allergies that could benefit from antihistamine medication.

Why is phenylephrine banned? ›

All the studies concluded that the decongestant was no more effective than a placebo. They also re-evaluated the initial findings used to support its OTC use. The agency found that the results were inconsistent, did not meet modern standards for study design and may have had data integrity issues.

Why has phenylephrine replaced pseudoephedrine? ›

Restrictions have been placed on the sale of PDE in the USA in an attempt to control the illicit production of methamphetamine. This has caused a switch from PDE to PE in many common cold and cough medicines.

Why was Sudafed taken off the market? ›

In 2005 federal law compelled retailers nationwide to move pseudoephedrine, sold as Sudafed, from over the counter (OTC) to behind it to combat its use in making illicit methamphetamine.

What is the downside to Sudafed? ›

Common side effects
  • Feeling sick (nausea) Try taking pseudoephedrine with or after a meal or snack. ...
  • Headaches. Make sure you rest and drink plenty of fluids. ...
  • A dry mouth. Chew sugar-free gum or suck sugar-free sweets.
  • Feeling restless, nervous or shaky. ...
  • Difficulty sleeping.

Why shouldn't you take Mucinex at night? ›

Mucinex and Nyquil Cold & Flu are two common over-the-counter remedies. They can be taken together, but not at night. Mucinex can cause coughing, making it hard to get a good night's sleep.

Is there a decongestant that actually works? ›

If you prefer to take a decongestant in pill form, Dr. Daiza recommends looking for ones that contain pseudoephedrine. “That active ingredient is still considered effective and is in many cold remedies,” she says.

What is a natural decongestant for the elderly? ›

It is important to always stay hydrated to prevent dehydration and help decongestion. Liquids such as plain water, clear soups, fresh juices, and honey lemon drinks are good to hydrate you, loosen the mucus, and clear that stuffy nose.

What decongestant does not cause rebound congestion? ›

If you're using nasal sprays that contain steroids to help your allergy symptoms, you can breathe easy. Nasal steroid sprays like fluticasone (Flonase) and mometasone (Nasonex) won't cause rebound congestion.

What is the most widely used decongestant? ›

Phenylpropanolamine, pseudoephedrine, and phenylephrine are the most common decongestants.

Which nasal decongestant actually works? ›

If you prefer to take a decongestant in pill form, Dr. Daiza recommends looking for ones that contain pseudoephedrine. “That active ingredient is still considered effective and is in many cold remedies,” she says.

What is a strong nasal decongestant? ›

Examples of combination nasal decongestants include: Advil Cold and Sinus®: Contains ibuprofen and pseudoephedrine. Claritin-D®: Contains loratadine and pseudoephedrine. Tylenol Sinus Severe Congestion Daytime®: Contains acetaminophen, guaifenesin and pseudoephedrine. Zyrtec-D®: Contains cetirizine and pseudoephedrine.

What is the best medicine for blocked sinuses? ›

Decongestants. These work by narrowing blood vessels to help lessen swelling that causes sinus congestion. Such medicines available without a prescription (Sudafed, others) are sold as liquids, tablets and nasal sprays. Pain relievers.

What is the best nasal spray for blocked sinuses? ›

For nasal congestion, we recommend Otrivine Sinusitis Relief Nasal Spray. The spray delivers an exact medicated dose of xylometazoline hydrochloride inside the nostril to relieve the nasal congestion as well as helping to ease the sinusitis pain and pressure that you may be feeling.


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