What over-the-counter (OTC) medications can be used to treat sinus infection symptoms?

Over-the-Counter Medications for Sinus Infection Symptoms

For viral sinus infections (common cold), use intranasal saline irrigation, oral decongestants (pseudoephedrine), and analgesics (acetaminophen or ibuprofen) for symptom relief; intranasal corticosteroids may provide modest benefit but are not FDA-approved for this indication. 1

Distinguishing Viral from Bacterial Sinusitis

Before selecting OTC treatments, understand that most sinus infections are viral and self-limited:

• Viral rhinosinusitis (VRS) typically peaks within 3 days and resolves within 10-14 days without antibiotics 1
• Bacterial sinusitis should be suspected only if symptoms persist beyond 10 days without improvement, worsen after initial improvement, or present with severe symptoms (high fever >39°C and purulent discharge for 3-4 consecutive days) 1, 2
• Colored nasal discharge alone does NOT indicate bacterial infection—it simply reflects inflammation and neutrophil presence, not bacteria 1

First-Line OTC Symptomatic Treatments

Nasal Saline Irrigation

• Recommended for all patients with minor improvements in nasal symptom scores and low risk of adverse effects 1
• Available in both physiologic and hypertonic concentrations 1
• Helps with mechanical removal of mucus and prevents crusting 3

Oral Decongestants (Pseudoephedrine)

• Provide symptomatic relief of nasal congestion and should be considered unless contraindicated 1
• Contraindications include uncontrolled hypertension and severe anxiety 1
• Pseudoephedrine plus acetaminophen combination is effective for early sinus symptoms during colds 4
• Available OTC as 30 mg tablets 5

Topical Nasal Decongestants

• Likely palliative but use MUST be limited to 3-5 days maximum to avoid rebound congestion and rhinitis medicamentosa 1
• Short-term use only 1

Analgesics/Antipyretics

• Acetaminophen or ibuprofen (NSAIDs) for pain and fever 1
• Combination of pseudoephedrine plus acetaminophen shows superior efficacy for sinus pressure, pain, and congestion compared to placebo 4

Intranasal Corticosteroids (Available OTC)

• May provide modest benefit for viral rhinosinusitis, though not FDA-approved for this indication 1
• Fluticasone propionate, fluticasone furoate, and mometasone furoate are preferred for safety (negligible bioavailability, once-daily dosing) 1
• Evidence shows 73% improvement with steroids vs 66% with placebo at 14-21 days—a small but real benefit with rare adverse events 1
• For acute bacterial sinusitis, intranasal corticosteroids are recommended as adjunctive therapy alongside antibiotics 6
• For chronic rhinosinusitis, intranasal corticosteroids are the mainstay of treatment requiring long-term adherence 1

Medications with Limited or No Evidence

Antihistamines

• No clinical studies support use in acute viral rhinosinusitis, though clinical experience suggests they may help with excessive secretions and sneezing 1
• May have a role if underlying allergic rhinitis is present 6
• First-generation antihistamine/decongestant combinations may help cough associated with postnasal drip 3

Expectorants and Cough Suppressants

• Guaifenesin (expectorant) and dextromethorphan (cough suppressant) lack evidence of clinical efficacy; use is based on patient and provider preference 1
• Available OTC but effectiveness not established 7

Zinc Lozenges

• Zinc acetate or gluconate lozenges ≥75 mg/day taken within 24 hours of symptom onset significantly reduce common cold duration 1
• Must be started early to be effective 1

Critical Pitfalls to Avoid

• Do NOT use topical decongestants beyond 3-5 days—this causes rebound congestion 1
• Do NOT assume colored nasal discharge means bacterial infection—this is a common misconception 1
• Do NOT rely solely on OTC medications for acute exacerbations of chronic rhinosinusitis—these patients should see a physician 1
• Antibiotics are NOT available OTC and are NOT indicated for viral rhinosinusitis, which comprises 98-99.5% of acute sinus infections 1

When to Seek Medical Attention

• Symptoms persisting beyond 10 days without improvement 1, 2
• Symptoms worsening after initial improvement 2
• Severe symptoms with high fever (>39°C) and purulent discharge for 3-4 consecutive days 2
• Recurrent episodes (≥3 per year) 6
• Severe facial pain, vision changes, or neurological symptoms suggesting complications 3