Decongestants

Decongestants are medicines that are used to help ease nasal congestion (blocked or stuffy nose) caused by the common cold, sinusitus, hay fever, other allergies and rhinitis. These medicines are available as nasal drops or sprays and as tablets and capsules. Nasal sprays or drops should not be used for more that seven days at a time. These medicines are not suitable for children under six years old.

What are decongestants?

Decongestants are medicines that are used to help ease nasal congestion (blocked or stuffy nose) caused by the common cold, sinusitis, hay fever or other allergies, and rhinitis. These conditions cause inflammation and swelling of the tissues and blood vessels that line the nasal passageway and sinuses. This, in turn, causes the nose to become blocked.

A number of decongestants are available in the UK. They include, ephedrine, oxymetazoline, phenylephrine, and xylometazoline. These medicines are available as sprays or drops that can be put into the nose (sometimes referred to as topical decongestants), as well as oral preparations (tablets or capsules). They come in various brand names. A combined tablet that contains a decongestant and a painkiller such as paracetamol is also available to buy from your pharmacy.

Topical decongestants usually contain oxymetazoline, xylometazoline, or ephedrine. Oral decongestants usually contain pseudoephedrine, or phenylephrine.

There are a number of other treatments that are sometimes used to treat nasal congestion. For example, saline nasal drops, and steam inhalations. Saline nasal drops are a popular treatment for a bunged-up nose in a baby. Steam inhalations may help to clear the nasal congestion, but they only have a temporary effect. They may be useful before bedtime to help you get off to sleep. 

This leaflet only discusses the use of medicines such as ephedrine, pseudoephedrine, oxymetazoline, phenylephrine, and xylometazoline for treating nasal congestion.

How do decongestants work?

Decongestants cause the small blood vessels in your nose, throat and sinuses to become narrower. This reduces the swelling and thickness of the lining of your nose, which is causing the congestion, and relieves the blocked-up feeling. Decongestant nasal sprays have an immediate effect to clear a blocked nose. Oral tablets and capsules may take a little longer to work because they need to be absorbed into the body from the stomach.

When are decongestants used or prescribed?

As discussed above, these medicines may be used or prescribed by your doctor to ease nasal congestion for people with the common cold, sinusitis, hay fever, other allergies or rhinitis.

If you have hay fever, they are helpful to use for a few days to clear a blocked nose when you first use a steroid nasal spray. The steroid can then get to the lining of the nose to work. If you have acute sinusitis, decongestants can relieve symptoms whilst you are waiting for your immune system to clear the infection. However, they are not thought to shorten the duration of sinusitis.

Decongestant nasal sprays and drops should only be used for about 5-7 days at a time. This is because, if they are used for longer than this, a rebound, more severe congestion of the nose often develops. Decongestant sprays and drops are thought to work better than oral tablets or capsules. Oxymetazoline and xylometazoline nasal preparations are thought to be more likely to cause rebound nasal congestion because they are the most potent. Oral decongestants are not thought to cause this problem when they are stopped.

Some important considerations

Some important considerations about decongestants relate to:

  • Children under 6 years old.
  • Taking other medicines.

Children under six years old

These medicines should not be used in children under six years old. In March 2009, an important statement was issued by the Medicines and Healthcare products Regulatory Agency (MHRA), which says:

  • The new advice is that parents and carers should no longer use over-the-counter (OTC) cough and cold medicines in children under six. There is no evidence that they work and they can cause side-effects, such as allergic reactions, effects on sleep or hallucinations.
  • For 6 to 12 year-olds these medicines will continue to be available but will only be sold in pharmacies, with clearer advice on the packaging and from the pharmacist. This is because the risks of side-effects are reduced in older children because they weigh more, get fewer colds and can say if the medicine is doing any good. More research is being done by industry on how well these medicines work in children aged 6-12 years.

Taking other medicines

It is important to remember that some medicines that you can buy OTC to treat, colds, and sinusitis contain other medicines as well. For example, some may contain paracetamol, and ibuprofen, and some contain alcohol. This is important if you are already taking paracetamol or ibuprofen to help the symptoms of your infection (for example, a high temperature). This is because you may take too much paracetamol or ibuprofen (overdose) but not be aware of it. Taking too much paracetamol can damage your liver.

You should not use these decongestants while you are taking a certain type of antidepressant called a monoamine-oxidase inhibitor (MAOI) and for two weeks after you stop it. This is because, when taken at the same time as an MAOI antidepressant, decongestants may cause very large increases in blood pressure (hypertensive crises).

What about side-effects?

Most people are able to take or use these medicines with very few, or no, side-effects. If side-effects do occur, they usually go away after a few days. Some people have reported nasal burning, irritation, and dryness after using decongestant nasal sprays and drops. Other side-effects that have been reported with nasal decongestants include nausea (feeling sick) and headache. Oral decongestants may cause anxiety, restlessness, problems with sleeping, and being aware of a fast or fluttering heartbeat.

See the leaflet that came with your medicines for more detailed information on the side-effects of these medicines.

Can I buy decongestants?

There are a large number of oral and nasal decongestants that you can buy from your local pharmacy and supermarket, with many different brand names.

Who cannot take decongestants?

People with heart problems, high blood pressure, kidney problems, diabetes, glaucoma, an overactive thyroid, prostate problems or taking an MAOI antidepressant should avoid taking decongestants. See the leaflet that came with your medicines for more detailed information on who should avoid taking these medicines. If you are unsure whether these medicines are safe for you, always ask your pharmacist or doctor for advice.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines may have caused. If you wish to report a side-effect, you will need to provide basic information about:

  • The side-effect.
  • The name of the medicine which you think caused it.
  • Information about the person who had the side-effect.
  • Your contact details as the reporter of the side-effect.

It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.