What can I do to relieve my nasal congestion?

Treatment for Blocked Nose (Nasal Congestion)

Start with isotonic saline nasal irrigation 2-4 times daily, which is safe, effective, and can be used long-term without any risk of dependency or side effects. 1

Immediate Relief Strategy

First-Line: Saline Nasal Irrigation

• Isotonic (normal) saline irrigation is more effective than hypertonic saline for relieving nasal congestion and should be your primary treatment 1
• Use 20 mL per nostril, 2-4 times daily 1
• This provides symptomatic relief by clearing mucus and improving nasal function without any risk of rebound congestion 1
• Benefits appear within days and can be continued indefinitely 1

Short-Term Decongestant Option (If Severe Congestion)

If your congestion is severe and preventing sleep or normal function, you may add:

• Oxymetazoline (Afrin) nasal spray for MAXIMUM 3 days only 2, 3
• Use 2 sprays per nostril twice daily 2
• CRITICAL WARNING: Do not exceed 3 days of use - rebound congestion (rhinitis medicamentosa) can develop as early as day 3-4, creating a cycle of worsening congestion that requires medical treatment 2, 3
• After 3 days, stop completely and do not restart 2, 3

Oral Decongestant Alternative

• Pseudoephedrine (Sudafed) 120mg extended-release once or twice daily temporarily relieves nasal congestion 4
• This can be used for several days without the rebound congestion risk of nasal sprays 4
• Avoid if you have high blood pressure, heart disease, or arrhythmias 5

If Congestion Persists Beyond 3-5 Days

Intranasal Corticosteroid Spray

If your blocked nose continues beyond a few days, start an intranasal corticosteroid spray (fluticasone, mometasone, or budesonide) - these are the most effective medications for controlling nasal congestion and all nasal symptoms 3, 6

• Use 2 sprays per nostril once daily 3
• Direct the spray away from your nasal septum (aim toward the outer wall of your nose) to prevent irritation and bleeding 3
• Onset of action begins within 12 hours, with continued improvement over 1-2 weeks 3
• These do NOT cause rebound congestion and can be used long-term safely 3
• Continue saline irrigation alongside the steroid spray 1

Combination Strategy for Severe Cases

If congestion is so severe that you cannot breathe through your nose at all:

1. Apply oxymetazoline first 3
2. Wait 5 minutes 3
3. Then apply the intranasal corticosteroid spray 3
4. This combination can be used safely for 2-4 weeks without causing rebound congestion, as the steroid prevents the rebound effect 3
5. After 2-4 weeks, discontinue oxymetazoline and continue only the steroid spray 3

Common Pitfalls to Avoid

• Never use over-the-counter decongestant nasal sprays (Afrin, oxymetazoline) for more than 3 days - this is the single most important rule to prevent rhinitis medicamentosa 2, 3, 5
• Do not buy nasal sprays with unknown ingredients online or from unregulated sources, as these may contain ingredients that cause severe rebound congestion 7
• Antihistamines alone are generally ineffective for nasal congestion unless you have allergies 1, 8
• Oral antihistamines and oral decongestants are less effective than intranasal corticosteroids for managing persistent congestion 3

When to Seek Medical Evaluation

If your nasal congestion persists beyond 2 weeks despite these treatments, you should see a healthcare provider to evaluate for:

• Chronic rhinosinusitis 1
• Allergic rhinitis 1, 9
• Nasal polyps 1
• Other structural abnormalities 9