MultiCare Health System

Back To Blog

  • Unplug my nose: the hidden dangers of decongestants

    by Sepehr Oliaei, MD, Otolaryngologist

    Cold and flu season is upon us. With it, comes the dreaded stuffy nose. Add to that the pressure of congested sinuses and painfully plugged ears and you’ll be willing to try almost anything for relief. But beware: some over the counter decongestants carry hidden danger.

    Are you ready for flu season? Find a vaccine.

    There are dozens of products available to treat cold symptoms that are readily available on the shelves of your neighborhood retail pharmacy, from pills that promise to relieve a multitude of symptoms, to colorful flavored syrups that are said to do the same for your children. The choice can be difficult at times, and, there are some choices that you may regret.

    Decongestant sprays

    The over-the-counter topical decongestant sprays oxymetazoline (Afrin, Dristan, Vicks Sinex, etc.) or phenylephrine (like Neo-Synephrine), may cause problems if used for longer than a few days.

    Afrin and other sprays work by shrinking small blood vessels in the nose that would normally contribute to the swelling and mucous drainage, thereby drying the nose and opening the breathing passages. They initially have an instant and almost magically powerful effect in relieving nasal, sinus and occasionally ear symptoms. They are easy to use and do not have a major effect on the rest of the body since they are not taken orally.

    However, with each subsequent dose, the effects of the drugs decrease. After a few days, the effects begin to wear off more quickly and are replaced by rebound congestion that remains long after your cold ends. This can create a vicious cycle, as the user begins to use the spray more frequently to combat the rebound congestion.

    In some of the worst cases I’ve seen of decongestant “addicts” (rhinitis medica mentosa is the technical term), users keep a bottle with them at all times and use it repeatedly throughout the day. They give themselves damage to the lining of the nose and constant congestion, and have an exceedingly difficult time trying to quit.

    What can you do to avoid this? Use Afrin spray or similar products for no more than 72 hours and only when you have an acute cold.

    Oral decongestants

    Oral decongestants, like pseudoephedrine (like Sudafed) or phenylephrine (like Vicks Sinex), may be a better option. However, oral decongestants may raise your blood pressure so be cautious, and talk to your doctor before use. Antihistamines can also help, but these can be sedating. Avoid driving or operating machinery after taking sedating antihistamines. Sedating antihistamines include Benadryl (diphenhydramine), mild to moderately sedating antihistamines include Zyrtec, and non-sedating antihistamines include Allegra and Claritin.

    Combination cold medicines

    When you use combination cold medicines that contain multiple products, be sure to carefully review these to make sure that it suits your needs. Most cold remedies contain acetaminophen (for pain relief and fever control) in addition to a topical decongestant and an antihistamine. Some may contain a cough suppressant as well.

    If your symptoms worsen despite taking these medications or you develop high fever and other severe symptoms that last more than a few days, it may be an indication of a bacterial infection, seek the consultation of your physician for help in those situations.

    Sepehr Oliaei, MD, is an otolaryngologist (ear, nose and throat specialist) at MultiCare ENT Specialists - Tacoma. To schedule an appointment or evaluation, call (253) 403-0065.

    Posted on Oct 25, 2013 in Ear, Nose and Throat (ENT)