What is a suitable medication for nasal congestion (nasal stuffiness) associated with an acute upper respiratory tract infection (cold)?

From the Guidelines

For congestion with a new onset cold, I recommend an over-the-counter decongestant like pseudoephedrine (Sudafed) or phenylephrine (Sudafed PE), as supported by the most recent evidence from 2020 1. Pseudoephedrine is more effective but requires ID at the pharmacy counter, while phenylephrine is available on shelves. Some key points to consider when using these medications include:

• Take pseudoephedrine 30-60 mg every 4-6 hours (not exceeding 240 mg daily) or phenylephrine 10-20 mg every 4 hours (maximum 60 mg daily) 1.
• Nasal decongestant sprays like oxymetazoline (Afrin) can provide quick relief but shouldn't be used for more than 3 days to avoid rebound congestion 1.
• Combination products containing antihistamines (like diphenhydramine) and decongestants may help if you have additional symptoms like sneezing or runny nose 1.
• These medications work by constricting blood vessels in nasal passages, reducing swelling and mucus production.
• Be cautious with decongestants if you have high blood pressure, heart disease, diabetes, or thyroid problems, as they can cause adverse effects such as insomnia, irritability, and palpitations 1.
• Saline nasal sprays and staying hydrated can also help thin mucus naturally without medication side effects. It's also important to note that the use of other OTC medical treatments such as decongestants, analgesics, antihistamines, and herbal medication is commonly reported and has been evaluated in recent studies 1. However, the benefits of these treatments must be weighed against the risk of adverse effects, and there is no evidence of effectiveness in young children 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 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™

A good medication to take when congested with a new onset cold is pseudoephedrine (PO), as it temporarily relieves sinus congestion and pressure, as well as nasal congestion due to the common cold 2. It is available in a non-drowsy and maximum strength formulation 2.

• Key benefits: temporarily relieves sinus congestion and pressure, and nasal congestion due to the common cold
• Formulation: available in 30 mg tablets, non-drowsy, and maximum strength 2

From the Research

Medication Options for Congestion with a New Onset Cold

• Pseudoephedrine is a commonly used decongestant that has been shown to be effective in reducing nasal congestion in adults with the common cold 3, 4, 5.
• The combination of desloratadine and pseudoephedrine has been found to be effective in treating allergic rhinitis and nasal congestion, with improvements in nasal congestion scores observed by day 2 6.
• Phenylpropanolamine and phenylephrine are also decongestants, but their efficacy varies, with phenylephrine being subject to first-pass metabolism and not bioavailable in currently recommended doses 4.
• Oxymetazoline is another decongestant that has been used in some studies, but its effectiveness is not as well established as pseudoephedrine 5.

Safety and Risks

• Pseudoephedrine has been associated with a small increased risk of insomnia, but overall, adverse events are rare and mild 3, 5.
• The use of pseudoephedrine has also been linked to misuse and abuse due to its CNS stimulant properties and structural similarity to amphetamine 7.
• There is insufficient data on the use of decongestants in children, and they are not recommended for use in children younger than 12 years of age with the common cold 3.

Dosage and Administration

• Single-dose decongestants have been shown to be effective in reducing nasal congestion in adults, but the evidence is limited 5.
• Multi-dose decongestants have also been found to be effective, with a small positive effect on subjective measures of nasal congestion in adults with the common cold 5.
• The combination of desloratadine and pseudoephedrine can be administered once or twice daily, with comparable reductions in nasal congestion scores 6.