January 7, 2011
Everything You Always Wanted to Know About Nasal Decongestants But Were Afraid to Ask
… Or, You Might Think That it’s Funny, But it’s Snot
As I mentioned last week, a miserable cold is striking lots of my patients, spreading grief across the land. The typical symptoms are nasal congestion, cough and the mother of all malaise. Since there is nothing proven to significantly decrease the duration of the common cold, the best doctors can do is treat the symptoms and encourage patience.
The mainstay of treating cold symptoms is a nasal decongestant. Besides letting you actually breathe through your nose, a nasal decongestant may decrease the post-nasal drip that’s making you cough. For people prone to sinus infections, it can keep your sinuses clear and prevent a sinus infection. For people traveling by air it can keep the eustachian tubes clear so your ears can equilibrate when the plane takes off and lands.
Unfortunately, there is much confusion about nasal decongestants, and many patients baffled by the options at the drug store buy a product that won’t help at all. So here’s a brief review of the nasal decongestants you should know about. Their most well-known brand names are in parentheses, but you should feel free to buy the same ingredient in the cheaper store brand.
Oxymetazoline (Afrin) nasal spray
Afrin is the most potent over-the-counter nasal decongestant. And you shouldn’t use it. The reason you shouldn’t use it is that after two to three days of use it causes rebound congestion. That means after you stop using it your nose gets more congested than before you start it. For that reason I generally recommend that patients only take it for only one day at a time. When is it at all useful to have a potent nasal decongestant for just one day? On the days you fly.
Pseudoephedrine is the next best thing to Afrin in terms of potency and it doesn’t cause rebound congestion. The problem is that patients no longer know how to find it. In California you have to show ID at the drug store counter and ask for it (though you don’t need a prescription). Because it’s a chemical cousin of ephedrine, it’s a stimulant. So some people feel too jittery on it or can’t sleep after taking it. It should not be taken by people with high blood pressure or breast-feeding mothers. It can cause (temporary) prostate enlargement, so older men may have difficulty urinating after taking it. Nevertheless, with all the above caveats, it’s probably the best thing to take during a cold to keep your nose and sinuses clear.
Phenylephrine is not a very effective nasal decongestant. Avoid it. Lots of patients end up buying it because (in California) it’s the only option on the shelf and they don’t know to ask at the counter for pseudoephedrine.
Ipratropium (Atrovent) nasal spray
Last but not least, Atrovent nasal spray is a prescription alternative that has very few side effects. It may be slightly less effective than pseudoephedrine but it’s the perfect solution for those who can’t take pseudoephedrine because of all the side-effects listed above. The reason that Atrovent nasal spray requires a prescription despite being much safer than pseudoephedrine, which doesn’t, is mysterious to me, though I am confident that our drug regulations are otherwise perfectly rational.
Now you can decongest a nose as well as the pros.
My review from last year about how to diagnose and manage The Common Cold
If you’re flying US Airways in January, make sure to grab a copy of the in-flight magazine. They’ve reprinted my post Sleep Deprivation Sabotages Dieting. And please make a nuisance of yourself on the plane by pointing out to other passengers how cool your doctor is. Thanks.
Important legal mumbo jumbo:
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