What are common nasal decongestants?

From the Guidelines

Common decongestants include pseudoephedrine (Sudafed), phenylephrine (Sudafed PE), and oxymetazoline (Afrin nasal spray), which work by narrowing blood vessels in the nasal passages, reducing swelling and congestion. These medications are often used to relieve nasal congestion caused by upper respiratory infections, allergic rhinitis, and nonallergic rhinitis 1.

Key Points to Consider

• Pseudoephedrine is generally more effective but requires ID to purchase in the US as it's kept behind the pharmacy counter, with a typical adult dose of 60mg every 4-6 hours or 120mg extended-release every 12 hours 1.
• Phenylephrine is available over-the-counter without restrictions but may be less effective, with a typical dose of 10mg every 4 hours 1.
• Nasal sprays like oxymetazoline provide quick relief but should not be used for more than 3 consecutive days to avoid rebound congestion 1.
• Side effects of oral decongestants may include increased blood pressure, insomnia, and nervousness, so they should be avoided by people with certain conditions like high blood pressure, heart disease, or hyperthyroidism 1.

Important Considerations for Use

• Oral decongestants should be used with caution in older adults and young children, and in patients with certain conditions, such as arrhythmias, angina pectoris, coronary artery disease, cerebrovascular disease, and hyperthyroidism 1.
• Topical decongestants can be considered for short-term and possibly for intermittent or episodic therapy of nasal congestion, but are inappropriate for regular daily use because of the risk for the development of rhinitis medicamentosa 1.
• Always follow package directions and consult a healthcare provider if you have underlying health conditions 1.

From the FDA Drug Label

Purpose: Nasal Decongestant Purpose Nasal decongestant

• Common decongestants include:
  • Oxymetazoline (IN) 2
  • Pseudoephedrine (PO) 3

From the Research

Common Decongestants

• Phenylpropanolamine, pseudoephedrine, and phenylephrine are the most common decongestants, as stated in the study 4
• Pseudoephedrine is widely used as an oral decongestant for the treatment of nasal congestion associated with common cold and allergy, as mentioned in the study 5
• Pseudoephedrine is also used for non-medical purposes due to its central nervous system (CNS) stimulant properties and structural similarity to amphetamine, as noted in the study 6

Decongestant Combinations

• Antihistamine-decongestant combinations, such as fexofenadine-pseudoephedrine, are used routinely for the treatment of seasonal allergic rhinitis, as discussed in the study 7
• The combination of an antihistamine and a leukotriene receptor antagonist, such as loratadine-montelukast, has also been shown to be efficacious in the treatment of seasonal allergic rhinitis, as mentioned in the study 7

Safety Considerations

• Oral, intranasal, and ophthalmic decongestants, such as pseudoephedrine, phenylephrine, and oxymetazoline, should be considered as second-line therapy during pregnancy, as stated in the study 8
• Further studies are needed to clarify the fetal safety of these decongestants, as noted in the study 8