What types of OTC decongestants are available?

Over-the-counter (OTC) drugs are medicines you can buy without a prescription from your doctor. OTC decongestants help relieve a stopped-up (stuffy) nose caused by a cold virus or the flu (influenza), sinusitis, or allergies. The only OTC decongestants available in pill form are phenylephrine (one brand name: Sudafed PE) and pseudoephedrine (one brand name: Sudafed 12 Hour).

Decongestant nose sprays and drops are also available over the counter. However, these products shouldn’t be used for more than 3 days because your body can become dependent on them. If you become dependent on these medicines, your nose may feel even more stuffed up when you quit using them. This is known as the “rebound” effect.

Is pseudoephedrine safe? Why is it sold behind the counter?

Yes, pseudoephedrine is a safe and effective decongestant when taken as directed. However, some people use OTC pseudoephedrine illegally by combining it with other products to make methamphetamine (“meth”), an illegal and dangerous street drug. To help prevent people from making meth, OTC medicines that contain pseudoephedrine are sold behind the counter. So, even though you may not need a prescription from your doctor to buy these medicines, you may still have to ask your pharmacist for them. Additional restrictions for pseudoephedrine include the following:

• Limit on the monthly amount an individual can purchase
• Requirement to show photo identification when purchasing the medicine
• Requirement for retailers to record and keep personal information about customers for at least 2 years after a purchase.

Some states have additional requirements for medicines containing pseudoephedrine. These requirements may include a doctor’s prescription.

How do decongestants work?

Decongestants work by narrowing blood vessels in the lining of the nose. This reduces how much blood flows through the area so that swollen tissue inside the nose shrinks and air can pass through more easily.

What are some common side effects of OTC decongestants?

Healthy adults who only use decongestants once in a while usually don’t experience side effects. However, anyone can experience side effects.

Decongestants can temporarily cause nervousness, dizziness, and sleeping problems. They can also cause heart palpitations (the feeling that your heart is racing) or high blood pressure.

Who should not take decongestants?

If decongestants make you feel restless or make it difficult for you to sleep, you may want to cut back on how much caffeine you drink while taking this medicine. Do not give decongestants to children 4 years of age or younger.

Don’t take decongestants if you have high blood pressure that is not controlled.

Talk to your doctor before using a decongestant if you have any of the following health problems:

• High blood pressure
• Glaucoma
• Heart conditions
• Thyroid problems
• Diabetes
• Prostate problems

Can OTC decongestants cause problems with any other medicines I take?

Decongestants can interact with many other medicines you take. If you take any of the medicines listed below, talk to your doctor before taking a decongestant:

• Medicines for asthma
• Diet pills
• Medicines for high blood pressure

Decongestants are often combined with antihistamines and/or pain relievers. If you take one of these combination medicines, it’s important to understand each of the active ingredients and the interactions they may have with other drugs you take.

In general, try to avoid combination products that treat many symptoms at once. For example, you might use a decongestant for a stuffy nose. Don’t use a decongestant combined with other active ingredients like cough medicine, antihistamines, or acetaminophen unless you are certain you aren’t taking other medicines that also contain those ingredients. This will help to keep you from taking too much of one of these ingredients.

Be sure not to take too much pseudoephedrine. Many OTC cold and allergy products and some prescription drugs contain pseudoephedrine. If you combine these drugs, you’ll take much more than you intend.

When should I talk to my doctor?

Call your doctor if your congestion lasts more than two weeks, if you have a fever, or if you have severe pain in your face or sinuses. If you are regularly using an OTC decongestant nasal spray to keep your nose clear, talk with your doctor about other treatments that are safer to use.