Should acetaminophen (Tylenol) and pseudoephedrine be taken for acute viral rhinosinusitis?

From the Guidelines

Management of Acute Viral Rhinosinusitis

Acetaminophen (Tylenol) and pseudoephedrine can be considered for the management of acute viral rhinosinusitis for symptomatic relief, but it is crucial to note that they do not address the underlying viral infection 1.

Symptomatic Relief

• Acetaminophen may help relieve headache and facial pain, and according to a systematic review, it may also help with nasal obstruction and rhinorrhoea, although it does not improve other cold symptoms 1.
• Pseudoephedrine, a decongestant, may provide additional relief from nasal congestion. The recommended dose of Tylenol Cold and Sinus is 1000mg of acetaminophen and 30mg of pseudoephedrine every 6 hours as needed, not to exceed 4 doses in 24 hours. However, its use should be limited to 3-5 days to avoid rebound congestion 1.

Considerations

• Oral decongestants like pseudoephedrine can result in side effects such as insomnia, loss of appetite, irritability, and palpitations, and should be used with caution in patients with certain conditions, such as hypertension, anxiety, and hyperthyroidism 1.
• The efficacy and safety of pseudoephedrine in children under 6 years old have not been well established, and its use in this age group should be carefully considered due to the risk of adverse effects 1.

Conclusion is not allowed, so the response ends here.

From the Research

Efficacy of Acetaminophen and Pseudoephedrine for Acute Viral Rhinosinusitis

• The combination of pseudoephedrine and acetaminophen has been shown to be effective in relieving symptoms attributed to the paranasal sinuses in patients with the common cold 2.
• A study published in 2000 found that pseudoephedrine plus acetaminophen decreased the mean overall sinus symptom assessment score by 1.30 +/- 0.06, compared to 0.93 +/- 0.06 in the placebo group (P < 0.029) 2.
• Another study found that acetaminophen may help relieve nasal obstruction and rhinorrhoea, but does not appear to improve some other cold symptoms, such as sore throat, malaise, sneezing, and cough 3.

Safety and Side Effects

• The combination of pseudoephedrine and acetaminophen was well-tolerated, with nervousness occurring in 4% of the treated subjects, compared to 0% in the placebo group (P = 0.007) 2.
• Acetaminophen has been associated with minor side effects, including gastrointestinal adverse events, dizziness, dry mouth, somnolence, and increased sweating 3.

Comparison to Other Treatments

• Intranasal xylometazoline has been shown to be effective in relieving nasal congestion in patients with the common cold, and is well-tolerated with minimal side effects 4.
• Topical adenosine has been found to inhibit inflammation and mucus production in a mouse model of viral acute rhinosinusitis, and may be a potential therapeutic option for the treatment of viral ARS 5.

Complications of Sinusitis

• Sinusitis can cause further morbidity and mortality through its impact on comorbid disorders, progression of inflammation, and extension of infection 6.
• Complications of acute bacterial rhinosinusitis (ABRS) include orbital infections, intracranial infections, and fungal complications, which can cause significant morbidity and mortality 6.