Over-the-counter (OTC) medicines 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 by the flu (influenza), sinusitis, or allergies. The only OTC decongestants available in pill form are phenylephrine (1 brand name: Sudafed PE) and pseudoephedrine (1 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. In most states, you do not need a prescription from your doctor to buy these medicines, but you will have to ask your pharmacist for them. Additional restrictions for pseudoephedrine include the following:
- Limit on the amount an individual can purchase each month
- 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.
How do I safely take OTC decongestants?
Read the directions on the drug facts label to learn how much medicine to take and how often to take it. If you have any questions about how much medicine to take, call your family doctor or pharmacist. Keep a record (1-page PDF) of the OTC medicines you are using and when you take them. If you need to go to the doctor, take this list with you.
Follow these tips to make sure you are taking the right amount of medicine:
- Take only the amount recommended on the medicine’s label. Don’t assume that more medicine will work better or quicker. Taking more than the recommended amount can be dangerous.
- If you are 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. They may have similar active ingredients that add up to be too much medicine.
How can I safely store OTC decongestants?
Store all medicines up and away, out of reach and sight of young children. Keeping medicines in a cool, dry place will help prevent them from becoming less effective before their expiration dates. Do not store medicines in bathrooms or bathroom cabinets, which are often hot and humid.
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 higher blood pressure than usual.
Who should not take decongestants?
Do not give decongestants to children 4 years of age or younger.
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. 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:
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 and/or pain relievers. If you take 1 of these combination medicines, it’s important to understand each of the active ingredients and the interactions they may have with other medicines 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, antihistamine, or acetaminophen, unless you are certain you aren’t taking other medicines that also contain those active ingredients. This will help you avoid taking too much of 1 of these ingredients.
To avoid taking too much pseudoephedrine, keep in mind that OTC cold and allergy medicines and some prescription medicines contain pseudoephedrine. If you combine these medicines, you’ll take much more than you intend.
When should I talk to my doctor?
Call your doctor if your congestion lasts more than 2 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.
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.