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Decongestants: OTC Relief for Congestion

Last Updated September 2023 | This article was created by familydoctor.org editorial staff and reviewed by Robert "Chuck" Rich, Jr., MD, FAAFP

What are OTC decongestants?

Decongestants are medicines that help relieve a congested (stuffy) nose. The congestion can be caused by a cold virus or by the flu, sinusitis, or allergies. Most decongestants come in pill or liquid form. When you buy decongestants at the store without a prescription, they are called over-the-counter (OTC) medicines.

Decongestant nose sprays and drops are also available over the counter. However, these products shouldn’t be used for more than 3 days. 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.”

The active ingredient in most decongestants is either phenylephrine or pseudoephedrine.

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

Pseudoephedrine is safe and effective when taken as directed. But some people use OTC pseudoephedrine illegally. They combine it with other products to make methamphetamine (“meth”). Meth is an illegal and dangerous street drug. To keep people from making meth, OTC medicines that contain pseudoephedrine are sold behind the counter. In most states, you don’t need a prescription from your doctor to buy these medicines. But you will have to ask your pharmacist for them. Additional restrictions include:

  • A limit on the amount you can purchase each month
  • Photo identification when purchasing the medicine
  • Customer purchasing history (stores must record and keep personal information about the customers who buy this medicine)

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

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How do decongestants work?

When your body detects a virus, the flu, sinusitis, or allergies, it sends extra blood to the blood vessels in the nose to fight the problem. This leads to swelling of the blood vessels and tissue in your nose. It makes you feel stuffy. It can be hard to breathe through your nose.

Decongestants work by narrowing the blood vessels in your nose. Swollen tissue inside the nose shrinks, and air can pass through more easily.

How can I safely take OTC decongestants?

Before you take OTC decongestants, read the directions on the drug facts label. It will tell you how much medicine to take and how often to take it. If you have any questions, call your doctor.

Follow these tips to make sure you’re taking the right amount of medicine:

  • Take only the amount shown on the medicine’s label. Don’t assume more medicine will work better or quicker. Taking more than the recommended amount can be dangerous.
  • If you’re taking a prescription medicine, ask your doctor if it’s okay to also take an OTC decongestant.
  • Don’t use more than 1 OTC decongestant medicine at a time unless your doctor says it’s okay. Multiple medicines may have similar active ingredients that add up to be too much medicine.

If using a liquid decongestant, use the measuring spoon that came with the medicine. This spoon is the right size for the dose you need. Don’t use a kitchen spoon.

When using decongestants, keep a record of the OTC medicines you’re using and when you take them. If you need to go to the doctor, take this list with you.

How can I safely store OTC decongestants?

Store all medicines up and away, out of reach and sight of young children. Keep medicines in a cool, dry place. This helps prevent them from becoming less effective before their expiration dates. Don’t store medicines in bathrooms, including in bathroom cabinets. These locations are often hot and humid.

Things to consider

Like any medicine, decongestants can sometimes cause side effects. They can temporarily cause nervousness, dizziness, and sleeping problems. They can cause heart palpitations (feeling like your heart is racing) or higher blood pressure. Healthy adults who only use them once in a while usually don’t experience side effects.

If decongestants make you feel restless or make it difficult for you to sleep, you may want to avoid taking them at bedtime. It also may help to cut back on caffeine. Or you may need to discontinue the medicine. Talk to your doctor about any questions.

Who shouldn’t take decongestants?

Don’t take decongestants if you have high blood pressure that isn’t controlled. Taking decongestants can raise your blood pressure even if it is controlled or nearly normal. You may need to look for an alternative to decongestants.

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

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

Don’t give decongestants to children younger than 6 years of age. Instead, there are other ways you can treat their symptoms:

  • For very young children, use a bulb syringe to remove mucus from their noses.
  • Use saline spray or drops to help loosen mucus.
  • Use a cool-mist humidifier. Place it in the child’s bedroom. The moisture created by the humidifier will help your child’s nose and throat not feel so dry.
  • Use ibuprofen (brand name: Advil) or acetaminophen (brand name: Tylenol) to lower a fever. However, always talk to your doctor before giving your child any medicine.

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:

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

Decongestants are often combined with antihistamines or pain relievers. It’s important to understand each of the active ingredients in combination medicines because they could cause interactions with other medicines. For safest practice, try to avoid combination products that treat many symptoms at once. Only use a combination decongestant if you aren’t taking other medicines that contain the same active ingredients. This will help you avoid taking too much of any 1 ingredient.

When should I talk to my doctor?

Call your doctor if:

  • Your congestion lasts more than 2 weeks
  • You have a fever
  • You have severe pain in your face or sinuses

If you’re regularly using an OTC decongestant nasal spray to keep your nose clear, talk with your doctor. There are other treatments that are safer to use.

Questions to ask your doctor

  • What kind of decongestant is best for me?
  • Am I taking any other medicines that will interact with a decongestant?
  • Do I need a prescription decongestant, or can I buy one over the counter?
  • Can I use a decongestant that’s combined with other medicines, like acetaminophen?
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