Decongestants are medicines used to relieve nasal congestion (stuffy nose).
A congested or stuffy nose is a common symptom of colds and allergies. This congestion results when membranes lining the nose become swollen. Decongestants relieve the swelling by narrowing the blood vessels that supply the nose. This reduces the blood supply to the swollen membranes, causing the membranes to shrink.
These medicines do not cure colds or reverse the effects of histamines—chemicals released as part of the allergic reaction. They will not relieve all of the symptoms associated with colds and allergies, only the stuffiness.
When considering whether to use a decongestant for cold symptoms, keep in mind that most colds go away with or without treatment and that taking medicine is not the only way to relieve a stuffy nose. Drinking hot tea or broth or eating chicken soup may help. There are also adhesive strips can be placed on the nose to help widen the nasal passages, making breathing through the nasal passages a bit easier when congestion is present.
Decongestant nasal sprays and nose drops may cause a problem called rebound congestion if used repeatedly over several days. When this happens, the nose remains stuffy or gets worse with every dose. The only way to stop the cycle is to stop using the drug. The stuffiness should then go away within about a week. Anyone who shows signs of severe rebound congestion should also contact his or her physician.
Do not use decongestant nasal sprays for more than three days. Decongestants taken by mouth should not be used for more than seven days. If the congestion has not gone away in this time, or if the symptoms are accompanied by fever, call a physician.
Do not use a decongestant nasal spray after the product's expiration date. If the product has become cloudy or discolored, throw it away and do not use it. Do not share droppers or spray bottles with anyone else, as this could spread infection. Do not let droppers and bottle tips touch countertops or other surfaces.
Some decongestants cause drowsiness. People who takes these drugs should not drive, use machines or do anything else that might be dangerous until they have found out how the drugs affect them.
In general, older people may be more sensitive to the effects of decongestants and may need to take lower doses to avoid side effects. People in this age group should not take long-acting (extended release) forms of decongestants unless they have previously taken a short-acting form with no ill effects.
Children may also be more sensitive to the effects of decongestants. Before giving any decongestant to a child, check the package label carefully. Some of these medicines are too strong for use in children. Serious side effects are possible if they are given large amounts of these drugs or if they swallow nose drops, nasal spray or eye drops. If this happens, call a physician or poison center immediately.
People with certain medical conditions or who are taking certain other medicines can have problems if they take decongestants. Before taking these drugs, be sure to let the physician know about any of these conditions:
ALLERGIES. Anyone who has had unusual reactions to decongestants in the past should let his or her physician know before these drugs or any similar drugs are prescribed. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.
PREGNANCY. In studies of laboratory animals, some decongestants have had unwanted effects on fetuses. However, it is not known whether such effects also occur in people. Women who are pregnant or who plan to become pregnant should check with their physicians before taking decongestants.
BREASTFEEDING. Some decongestants pass into breast milk and may have unwanted effects on nursing babies whose mothers take the drugs. Women who are breastfeeding should check with their physicians before using decongestants. If they need to take the medicine, it may be necessary to bottle feed the baby with formula while taking it.
OTHER MEDICAL CONDITIONS. Anyone with heart or blood vessel disease, high blood pressure, diabetes, enlarged prostate, or overactive thyroid should not take decongestants unless under a physician's supervision. The medicine can increase blood sugar in people with diabetes. It can be especially dangerous in people with high blood pressure, as it may increase blood pressure.
Before using decongestants, people with any of these medical problems should make sure their physicians are aware of their conditions:
- history of mental illness
Decongestants may have a variety of side effects, and may also interact with other medications the patient is taking.
DECONGESTANT NASAL SPRAYS AND NOSE DROPS. The most common side effects from decongestant nasal sprays and nose drops are sneezing and temporary burning, stinging, or dryness. These effects are usually temporary and do not need medical attention. If any of the following side effects occur after using a decongestant nasal spray or nose drops, stop using the medicine immediately and call the physician:
- increased blood pressure
- fast, slow, or fluttery heartbeat
- sleep problems
DECONGESTANTS TAKEN BY MOUTH. The most common side effects of decongestants taken by mouth are nervousness, restlessness, excitability, dizziness, drowsiness, headache, nausea, weakness, and sleep problems. Anyone who has these symptoms while taking decongestants should stop taking them immediately.
Patients who have these symptoms while taking decongestants should call the physician immediately:
- increased blood pressure
- fast, irregular, or fluttery heartbeat
- severe headache
- tightness or discomfort in the chest
- breathing problems
- fear or anxiety
- trembling or shaking
- convulsions (seizures)
- pale skin
- painful or difficult urination
Other side effects may occur. Anyone who has unusual symptoms after taking a decongestant should get in touch with his or her physician.
Interactions with other medicines
Decongestants may interact with a variety of other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Do not take decongestants at the same time as these drugs:
- Monoamine oxidase inhibitors (MAO inhibitors) such as phenzeline (Nardil) or tranylcypromine (Parnate), used to treat conditions including depression and Parkinson's disease. Do not take decongestants at the same time as a MAO inhibitor or within two weeks of stopping treatment with an MAO inhibitor unless a physician approves.
- Other products containing the same or other decongestants
In addition, anyone who takes decongestants should let the physician know all other medicines he or she is taking. Among the drugs that may interact with decongestants are:
- tricyclic antidepressants such as imipramine (Tofranil) or desipramine (Norpramin)
- the antidepressant maprotiline (Ludiomil)
- amantadine (Symmetrel)
- medicine to relieve asthma or other breathing problems
- methylphenidate (Ritalin)
- appetite suppressants
- other medicine for colds, sinus problems, hay fever or other allergies
- beta-blockers such as atenolol (Tenormin) and propranolol (Inderal)
- digitalis glycosides, used to treat heart conditions
The list above does not include every drug that may interact with decongestants. Be sure to check with a physician or pharmacist before combining decongestants with any other prescription or nonprescription (over-the-counter) medicine.
Decongestants are sold in many forms, including tablets, capsules, caplets, gelcaps, liqui-caps, liquids, nasal sprays, and nose drops. These drugs are sometimes combined with other medicines in cold and allergy products designed to relieve several symptoms. Some decongestant products require a physician's prescription, but there are also many nonprescription (over-the-counter) products. Ask a physician or pharmacist about choosing an appropriate decongestant.
Commonly used decongestants include oxymetazoline (Afrin and other brands) and pseudoephedrine (Sudafed, Actifed, and other brands). The decongestant oxymetazoline is also used in some eye drops to relieve redness and itching.
The recommended dosage depends on the drug. Check with the physician who prescribed the drug or the pharmacist who filled the prescription for the correct dosage, and always take the medicine exactly as directed. If using nonprescription (over-the-counter) types, follow the directions on the package label or ask a pharmacist for assistance. Never take larger or more frequent doses, and do not take the drug for longer than directed.
Anyone considering taking a decongestant should take a close look at the labels of any already in their medicine cabinet. In 2000, the Food and Drug Administration prohibited over-the-counter sales of medicines containing the decongestant phenylpropanolamine. The medicine is associated with an increased risk of stroke in people ages 18 to 49, especially women. Many cold remedies contained this medicine. Contact a pharmacist if there is any question about the ingredients in a medication. Over-the-counter remedies containing phenylpropanolamine should be discarded.
The desired result when taking decongestants is the short-term relief of nasal congestion.
Henderson, Charles W. "Voluntary Withdrawal of Cold and Allergy Products Announced." Medical Letter on the CDC and FDA, November 26, 2000.
"An Ingredient Under Fire: Drugmakers are Jittery Afteran FDA Panel Ruling." Newsweek, October 30, 2000: 59.
Medline Plus Health Information. U.S.National Library of Medicine. 〈http://www.nlm.nih.gov/medlineplus〉.
Fetus— A developing baby inside the womb.
Hallucination— A false or distorted perception of objects, sounds, or events that seems real. Hallucinations usually result from drugs or mental disorders.
Decongestants are medicines used to relieve nasal congestion (stuffy nose).
Decongestant drugs are chemically similar to epinephrine and norepinethrine, which are hormones that cause excitation in the body. These hormones cause constriction of blood vessels. A stuffy nose is caused by dilated blood vessels, which swell the nasal passages and make it harder to breathe.
Because these drugs have actions similar to the natural hormones, they have been used for purposes other than the treatment of nasal congestion. Some of these uses, such as treatment of hypotension, can be very important. Some of these drugs have also been abused because of their stimulant effects.
A congested or stuffy nose is a common symptom of colds and allergies . This congestion results when membranes lining the nose become swollen. Decongestants relieve the swelling by narrowing the blood vessels that supply the nose. This narrowing reduces the blood supply to the swollen membranes, causing them to shrink.
These medicines do not cure colds or reverse the effects of histamines, chemicals released as part of the allergic reaction. They will not relieve all of the symptoms associated with colds and allergies, only the stuffiness.
Nasal decongestants may be used in many forms, including tablets, nose drops, and nasal sprays.
Because decongestants have the potential for many side effects and adverse effects, they must be dosed carefully.
When decongestants are used in the form of nose drops or nasal spray, the following adverse effects are common:
- increased nasal discharge
- altered sense of taste
The following adverse effects are very rare when decongestants are given by drops or spray and also quite rare but possible when given by mouth:
- difficulty breathing
Even more severe adverse effects are possible when decongestants are taken in large overdose. These include heart problems and tremors.
Some people complain of rebound congestion, which occurs when, after the decongestant has worn off, the congestion returns even worse than before.
Decongestants do not have any interactions with drugs that would be taken by a generally healthy child. Even so, people using decongestants should review their drug therapy with a physician or pharmacist before starting treatment.
Although decongestants have the potential for serious side effects and adverse effects, they are very safe when used properly. However, nasal decongestants should only be used for three days at a time to avoid significant rebound effect. The most severe adverse effects can be avoided by using nose drops and nasal sprays in place of tablets or capsules.
Parents administering these drugs to their children should use nose drops or nasal spray and avoid tablets or capsules, which are more likely to cause adverse effects. They should also review the proper administration of nose drops and nasal spray with a physician or nurse.
Decongestants are subject to abuse. Parents should observe the behavior of adolescents and teens who may be purposely overdosing on these drugs.
In the event of severe adverse effects, parents should get medical care immediately for their child.
Constricted —Made smaller or narrower.
Dilate —To expand in diameter and size.
Hypotension —Low blood pressure.
Tremor —Involuntary shakiness or trembling.
See also Cough suppressants; Expectorants.
Beers, Mark H., and Robert Berkow, eds. The Merck Manual, 2nd home ed. West Point, PA: Merck & Co., 2004.
Mcevoy, Gerald, et al. AHFS Drug Information 2004. Bethesda, MD: American Society of Healthsystems Pharmacists, 2004.
Siberry, George K., and Robert Iannone, eds. The Harriet Lane Handbook, 15th ed. Philadelphia: Mosby Publishing, 2000.
Daggy, A., et al. "Pediatric Visine (tetrahydrozoline) ingestion: case report and review of imidazoline toxicity." Veterinary and Human Toxicology 45, no. 4 (August 2003): 210–2.
Leung, A. K., and J. D. Kellner. "Acute sinusitis in children: diagnosis and management." Journal of Pediatric Health Care 18, no. 2 (March-April 2004): 72–6.
Watanabe, H., et al. "Oxymetazoline nasal spray three times daily for four weeks in normal subjects is not associated with rebound congestion or tachyphylaxis." Rhinology 41, no. 3 (September 2003): 167–74.
American Academy of Emergency Medicine. 555 East Wells Street, Suite 1100, Milwaukee, WI 53202–3823. Web site: <www.aaem.org>.
American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: <www.aap.org>.
Allergic Child. Available online at <www.allergicchild.com/> (accessed October 17, 2004.
HealthyMe! Available online at <www.ahealthyme.com/topic/childrens;jsessionid=5KZUMWMWHEM12CTYAEOS4EQ> (accessed October 17, 2004.)
Deanna M. Swartout-Corbeil, R.N.
Samuel Uretsky, PharmD
Alan W. Cuthbert
de·con·ges·tant / ˌdēkənˈjestənt/ • adj. (chiefly of a medicine) used to relieve nasal congestion.• n. a decongestant medicine.