The nasal congestion that commonly occurs with colds, allergies and sinusitis characteristically causes symptoms such as a runny nose, blocked nasal airways, sinus pressure and middle ear pressure. These uncomfortable symptoms may be relieved by use of a nasal decongestant. Oral and topical decongestants act on the blood vessels to decrease swelling of the nasal tissues. Many over-the-counter nasal decongestants are available for children and adults.
Pseudoephedrine
Pseudoephedrine interacts with nerve receptors to cause blood vessel narrowing, as noted in the National Library of Medicine PubMed Health entry on this medication. Blood vessel constriction decreases fluid leakage and associated swelling of the inflamed nasal tissues, reducing nasal congestion. Decongestion of nasal and sinus tissues can promote sinus drainage. Decreased nasal tissue swelling may also relieve middle ear pressure by facilitating reopening of the tube between the middle ear and nasal cavity. Pseudoephedrine is available as a single-ingredient product and in many combination drug products for colds and sinusitis.
The vasoconstrictive properties of pseudoephedrine may aggravate high blood pressure, or hypertension. This drug cannot be taken with monoamine oxidase inhibitors, or MAOIs, due to an risk for severe hypertension. Other possible side effects include heart arrhythmias, nervousness, restlessness, dry mouth, insomnia and difficulty urinating.
Federal and state laws limit the sale of pseudoephedrine. As noted by the U.S. Department of Justice Drug Enforcement Administration, the “Combat Methamphetamine Epidemic Act 2005” requires pseudoephedrine products be kept behind the pharmacy counter, limits the amount of pseudoephedrine that can be purchased, and requires record keeping to ensure compliance with sales limits.
Phenylephrine
Like pseudoephedrine, phenylephrine interacts with nerve cell receptors to cause blood vessel constriction. The indications and use of phenylephrine mirror those of pseudoephedrine. Oral phenylephrine is available in single-ingredient products and in many over-the-counter combination products marketed for the relief of cold, allergy and sinus symptoms. Intranasal phenylephrine sprays are also available. Contraindications to the use of phenylephrine include severe high blood pressure, the use of MAOIs, certain fast heart rhythm abnormalities and severe coronary artery disease. The National Library of Medicine PubMed Health entry on phenylephrine notes that possible side effects include dizziness, insomnia and nervousness.
Oxymetazoline
Oxymetazoline is a topical nasal decongestant that causes constriction of the local blood vessels with an associated decrease in swelling and congestion. The medication is available over the counter as nose drops or a nasal spray. MayoClinic.com notes that possible side effects of ozymetazoline include increased nasal congestion, sneezing and dryness or burning inside the nose. Absorption of the drug into the bloodstream may cause rapid heart rate, increased blood pressure, insomnia, nervousness and dizziness.
