Decongestants are medicines that are used to help ease a blocked or stuffy nose (nasal congestion). They may be helpful for congestion caused by various conditions. Most commonly, decongestants are used for a cold, sinusitis, hay fever, allergies and rhinitis. These medicines are available as nose drops or nasal sprays and also as tablets, capsules and syrup. Decongestant nose drops or nasal sprays should not be used for more than seven days at a time.
These medicines are not suitable for children under 6 years old.
What are decongestants?
Decongestants are medicines that are used to help ease a blocked or stuffy nose (nasal congestion). Conditions which cause congestion include:
These conditions cause 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:
Some are available as sprays or drops that can be put into the nose (sometimes referred to as topical decongestants). Some are available to take by mouth as a tablet or syrup. Some are available in both forms.
These medicines come in various brand names. Many are available to buy over the counter from your pharmacy. They may also be available as a combined tablet that contains a decongestant and a painkiller such as paracetamol.
There are a number of other options that are sometimes used to treat nasal congestion. For example, the following may be helpful:
- Salt water (saline) nose drops. These are a popular treatment for a bunged-up nose in a baby.
- Steam inhalations. Steam may help to clear the nasal congestion but only has an effect for a short time. This may be useful before bedtime to help you get off to sleep.
How do decongestants work?
Most 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. As it is this swelling causing the congestion, the medication improves the blocked-up feeling.
Ipratropium nasal spray works slightly differently by drying up the secretions of the nose.
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 guts.
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 more effectively. 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 nose drops should only be used for about 5-7 days at a time. If they are used for longer than this a rebound, more severe congestion of the nose often develops. Oxymetazoline and xylometazoline nasal preparations are thought to be more likely to cause rebound nasal congestion because they are the strongest. Oral decongestants are not thought to cause this problem when they are stopped. Decongestant sprays and drops are thought to work better than oral tablets or capsules.
Some important considerations
Some important considerations about decongestants relate to:
- Children under 6 years old.
- Taking other medicines.
Children under 6 years old
These medicines should not be used in children under 6 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 6. 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. The risks of side-effects are reduced in older children. This is because they weigh more, get fewer colds and can say if the medicine is doing any good. These medicines should not be used for more than five days in children aged 6 to 12. 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 to treat colds or sinusitis contain other medicines as well. For example, some may contain paracetamol or 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). You may take too much paracetamol or ibuprofen (overdose) without realising. Taking too much paracetamol can damage your liver.
You should also 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.
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 nose drops. Other side-effects that have been reported with nasal decongestants include feeling sick (nausea) 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 or supermarket. They come in many different brand names.
Who cannot take decongestants?
Some people should avoid taking decongestants. This includes people who have:
- Heart problems.
- High blood pressure.
- Kidney problems.
- An overactive thyroid.
- Prostate problems.
- Depression and are taking an MAOI antidepressant.
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 or any other healthcare products 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.
- 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.
Further reading & references
- British National Formulary; NICE Evidence Services (UK access only)
- Sinusitis; NICE CKS, October 2013 (UK access only)
- Common Cold; NICE CKS, July 2015 (UK access only)
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Mary Harding
Prof Cathy Jackson