From the Guidelines
For treating congestion from the emergency department, I recommend prescribing a combination of an oral decongestant and an intranasal corticosteroid, as this approach has been shown to provide both immediate and long-term relief of nasal congestion, with a focus on minimizing morbidity, mortality, and improving quality of life. Pseudoephedrine (Sudafed) 60mg every 6 hours or 120mg extended-release every 12 hours for 3-5 days can provide immediate relief of nasal congestion, as supported by the study 1. This should be paired with fluticasone propionate nasal spray (Flonase) 1-2 sprays per nostril once daily for 1-2 weeks, as intranasal corticosteroids like fluticasone have been found to reduce inflammation in the nasal passages, providing longer-term relief 1. Some key points to consider when prescribing these medications include:
- Pseudoephedrine works by stimulating alpha-adrenergic receptors, causing vasoconstriction of blood vessels in the nasal passages, which reduces swelling and congestion.
- Patients should be advised that pseudoephedrine is kept behind the pharmacy counter due to restrictions (though no prescription is required in most states) and should be avoided in patients with hypertension, cardiovascular disease, glaucoma, or hyperthyroidism, as noted in the study 1.
- For patients with these conditions, consider prescribing oxymetazoline (Afrin) nasal spray, but limit use to 3 days maximum to prevent rebound congestion, as cautioned in the study 1.
- Adequate hydration and saline nasal sprays can be helpful adjuncts to these medications. It's also important to note that oral decongestants, such as pseudoephedrine, can cause side effects like insomnia, loss of appetite, irritability, and palpitations, and should be used with caution in patients with certain conditions, as discussed in the study 1. Overall, the combination of an oral decongestant and an intranasal corticosteroid is a effective treatment approach for congestion, and by considering the potential side effects and interactions, we can minimize morbidity, mortality, and improve quality of life for our patients.
From the FDA Drug Label
Uses • temporarily relieves sinus congestion and pressure • temporarily relieves nasal congestion due to the common cold, hay fever or other upper respiratory allergies Purpose Nasal decongestant Principal Display Panel Compare to Sudafed® Congestion active ingredient Pseudoephedrine Hydrochloride, 30 mg Nasal Decongestant MAXIMUM STRENGTH • SINUS PRESSURE • SINUS CONGESTION 24 TABLETS actual size NON-DROWSY Padagis™
- Pseudoephedrine is a good prescription treatment for congestion, as it is a nasal decongestant that can temporarily relieve sinus congestion and pressure 2, 2, 2.
- It is effective in relieving nasal congestion due to the common cold, hay fever, or other upper respiratory allergies.
- The medication is available in a maximum strength formulation and is non-drowsy.
From the Research
Treatment of Congestion from ED
- Nasal congestion is a common side effect of erectile dysfunction (ED) treatments, particularly those that involve phosphodiesterase type 5 inhibitors (PDE5i) such as sildenafil 3.
- Decongestants, such as pseudoephedrine, can be effective in relieving nasal congestion 4, 5.
- Combination therapy of an antihistamine and a decongestant, such as desloratadine and pseudoephedrine, can be a convenient and efficacious treatment for allergic rhinitis and nasal congestion 6.
- Pseudoephedrine is a commonly used decongestant that can provide relief from nasal congestion, but it can also have central nervous system stimulant properties and be misused as a substitute for amphetamine or methamphetamine 5.
Management of ED
- Erectile dysfunction is a common male sexual dysfunction that can be associated with a range of factors, including increasing age, depression, obesity, and cardiovascular disease 7.
- Treatment of ED typically involves lifestyle modification, reduction of comorbid vascular risk factors, and pharmacotherapy with PDE5i such as sildenafil, tadalafil, or vardenafil 7.
- Patient-administered intracorporal injection therapy and surgical treatment with penile implants are also effective treatment options for ED, particularly in men who fail to respond to oral pharmacological agents 7.