Bay Area Medical Information
Over-the-Counter Decongestants
Decongestants can relieve nasal stuffiness due to allergies or colds. The following are OTC:

1) Oral decongestant ingredient: pseudoephedrine is found in Sudafed, Contact Non-Drowsy, & most combination cold products and most recently phenylephrine is being used as the main active ingredient. Phenylephrine is not as effective as pseudoephedrine.

Until recently, pseudoephedrine has been the more commonly used decongestant and the main active ingredient in many popular nonprescription cold and allergy medications. Unfortunately, pseudoephedrine is also a key ingredient in the production of methamphetamine, a highly addictive illegal stimulant. In an effort to combat methamphetamine production, federal law has recently required that all nonprescription medications containing pseudoephedrine be taken off drugstore shelves and be stored behind the counter in the pharmacy. To purchase these medications, you must go to the pharmacy, show some form of government-issued identification, and sign a logbook.

Some drug companies are concerned that this inconvenience may discourage people from buying cold and allergy medications containing pseudoephedrine. As a result they are quietly reformulating these products — removing the decongestant ingredient or replacing pseudoephedrine with phenylephrine. The label has not changed, and many people naturally assume that the product is unchanged as well.

2) Nasal Sprays with a Decongestant ingredient: oxymetazoline is in Afrin, Neo-Synephrine, Sinex and phenylephrine is in Neo-Synephrine, and Sinex

3) Saline Nasal Spray (salt water) every 2 hours or as needed is the safest method to help clear the nose and avoids all of the side effects listed below:

Caution--Important facts about decongestants:
Decongestants taken by mouth can have a number of side effects:

  • Anxiety/palpitations/Insomnia:Taking a decongestant gives most people a caffeine-like reaction. It may make you feel anxious, increase your pulse, make you feel like you have a racing heart or cause insomnia. Most combination cold products will combine a decongestant, which is usually stimulating, with an antihistamine, which is usually sedating, to achieve a product that is suitable for night-time cold relief, in most people. It is important to realize that individual reactions to these ingredients can vary. One person can take the night-time cold medicine and be sound asleep within 20 minutes, while another person can take the same medicine and be wide awake most of the night. In general, however, if the product says it's for night-time, most people will feel sedated after taking it.
  • Elderly are often advised to avoid decongestants and combination cold products altogether due to the potential for serious side effects. Saline nasal spray is recommended as an alternative.
  • People with chronic medical conditions--Check with your doctor if you have chronic medical conditions such as thyroid disease or high blood pressure before using any medication for a cold.
    Decongestant nasal sprays may work more quickly but have a rebound effect if you use them more than 3-5 days. They are best for short-lived colds and not for persistent allergies.
  • Phenylpropanolamine (PPA) is an ingredient that previously was widely available in weight loss drugs and decongestants. Although an effective decongestant and appetite suppressant, it has been associated with hemorrhagic stroke and most drugs containing this ingredient have been reformulated. However, there are still a small number of cold remedies and weight loss drugs still on the market with this ingredient. If you find this ingredent in your medicine cabinet, throw it out.

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