From the Guidelines
Nasal decongestants should be used with caution in patients requiring nursing care, and their use should be limited to the shortest duration possible due to the risk of rhinitis medicamentosa and other adverse effects. The most common decongestants, pseudoephedrine and phenylephrine, can relieve nasal congestion but may result in side effects such as insomnia, irritability, and palpitations 1. If a patient needs to use a decongestant, they should take the lowest effective dose for the shortest possible duration, preferably using pseudoephedrine no more than 2-3 days at recommended doses (30-60mg every 4-6 hours, not exceeding 240mg daily) 1. Topical nasal sprays like oxymetazoline (Afrin) or saline sprays are preferable alternatives as they have minimal systemic absorption 1. Non-pharmacological approaches should be tried first, including:
- Nasal saline rinses
- Humidifiers
- Adequate hydration
- Elevating the head while sleeping If congestion persists beyond a few days or is accompanied by fever, severe headache, or colored discharge, the patient should consult a healthcare provider for further evaluation and guidance 1. It is essential to instruct patients on the risk of rhinitis medicamentosa when using intranasal decongestants for more than 3 days 1.
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 Purpose Nasal decongestant
Nasal Decongestants are used to relieve nasal congestion. The provided drug labels for pseudoephedrine (PO) 2 and oxymetazoline (IN) 3, and another pseudoephedrine (PO) 2 indicate their use as nasal decongestants.
- Pseudoephedrine (PO) is used to temporarily relieve nasal congestion due to the common cold, hay fever, or other upper respiratory allergies.
- Oxymetazoline (IN) and another pseudoephedrine (PO) are used as nasal decongestants. However, there is no information regarding nursing care. The FDA drug label does not answer the question.
From the Research
Nasal Decongestants
- Nasal decongestants are available over the counter and provide rapid relief of nasal obstruction for conditions of short duration, such as the common cold 4.
- Topical decongestants can be used for a limited time, but prolonged use may lead to rebound mucosal hyperaemia with persistent nasal obstruction and refractoriness to further effects of decongestants 4.
Effectiveness of Nasal Decongestants
- A study found that oxymetazoline nasal spray three times daily for four weeks in normal subjects is not associated with rebound congestion or tachyphylaxis 4.
- Another study found that nasal decongestants may have a small positive effect on subjective measures of nasal congestion in adults with the common cold, but the clinical relevance of this small effect is unknown 5.
- A study also found that topical nasal decongestant oxymetazoline (0.05%) provides relief of nasal symptoms for 12 hours 6.
Nursing Care
- Nurses should be aware of the potential risks and benefits of nasal decongestants and educate patients on their proper use 7.
- Nurses should also monitor patients for adverse effects, such as rebound congestion, and adjust treatment as needed 5.
- The selection of a decongestant should be based on the individual patient's needs and the cause of nasal congestion, and nurses should be aware of the different types of decongestants available, including topical and oral agents 8.