Decongestants
Decongestants are medications designed to relieve nasal and sinus congestion caused by conditions such as colds, sinus infections, and allergies. They work primarily by stimulating specific receptors in the smooth muscle of the upper respiratory tract, leading to the constriction of blood vessels and reduction of inflamed mucous membranes. Common forms of decongestants include both topical sprays and oral preparations, with several well-known examples such as pseudoephedrine and phenylephrine. While decongestants can provide temporary relief, their effectiveness is debated, particularly regarding repeated use, as some studies suggest limited benefits beyond a single dose.
Safety is a concern with decongestants, especially for specific populations, including the elderly, children, and individuals with certain health conditions like high blood pressure or heart disease. Overuse of topical decongestants can lead to rebound congestion, while excessive doses can cause severe side effects. Recent discussions around the efficacy of decongestants, particularly phenylephrine, have led to calls for reevaluation of their availability. Alternatives, such as antihistamines, hot showers, and hydration, are often suggested for safer relief from congestion. Overall, while decongestants remain popular, their role in treatment continues to draw scrutiny and debate within the medical community.
Decongestants
Anatomy or system affected: Circulatory system, ears, nose, respiratory system, throat
Definition: Oral and topical medications that are used to relieve nasal and sinus congestion and to promote the opening of collapsed Eustachian tubes
Indications and Procedures
Decongestants are used to shrink inflamed mucous membranes, promote drainage, or open collapsed Eustachian tubes. They are often used for temporary relief of congestion caused by an upper respiratory tract infection (a cold), a sinus infection, hay fever and other nasal allergies. They do this by promoting both nasal and sinus drainage. They are also often used as adjunctive therapy in the treatment of middle-ear infection (otitis media) to decrease congestion around the openings of the Eustachian tubes. They may relieve the ear pressure, blockage, and pain experienced by some people during air travel. Careful scientific evaluation of the effectiveness of decongestants, however, has shown somewhat contradictory results.
The action of decongestants is accomplished primarily through stimulation of specific receptors in the smooth muscle of the upper respiratory tract, which in turn leads to constriction of the blood vessels and shrinkage of the mucous membranes. This improves air flow through the upper respiratory tract and relieves the sensation of stuffiness.
Uses and Complications
Decongestants may be applied topically, as sprays or drops, or taken by mouth. Commonly used decongestants include ephedrine, epinephrine, naphazoline, oxymetazoline, phenylephrine, pseudoephedrine, tetrahydrozoline, and xylometazoline. Some of these drugs are available over the counter and some by prescription only.
Oral preparations must be used with caution in elderly persons, children, and people with high blood pressure or other cardiac problems. If used as directed, decongestants do not usually cause excessive increases in blood pressure, overstimulate the heart, or change the distribution of blood in the circulatory system. The topical preparations are somewhat safer, because they are less likely to cause side effects, but they must also be used with caution.
The major advantage of oral decongestants is their long duration of action. Topical decongestants work more quickly but last a shorter period of time and are more likely to cause irritation of the tissues to which they are applied. If used too often or for too long a period of time (more than three to five days), nasal preparations may lead to a condition called rhinitis medicamentosa or rebound congestion, in which the congestion may be worse than before the person started using the medication.
People who take a certain type of antidepressant medication called a monoamine oxidase inhibitor (MAOI) and those with severe high blood pressure or heart disease should not take decongestants at all. People with thyroid disease, diabetes mellitus, glaucoma, or an enlarged prostate gland should take these drugs only after consulting a health care professional. Specific decongestants are contraindicated in infants and children.
People who take excessive doses of decongestants or who take them with other drugs that stimulate the central nervous system may experience insomnia, restlessness, dizziness, tremors, or nervousness. Overdose or long-term use of high doses may lead to hallucinations, convulsions, cardiovascular collapse, or even death.
Perspective and Prospects
Although decongestants have been widely used for decades, evidence-based medicine reveals few valid studies indicating that decongestants do, in fact, overcome illnesses. Systematic and careful reviews of the scientific studies available in the medical literature suggest that a single dose of a decongestant may relieve the stuffiness associated with the common cold in adults, but that no evidence exists for the usefulness of repeated doses. In people with a cough, a combination decongestant-antihistamine provides some relief in adults but not in children. In children with otitis media, there is a small statistical benefit from use of a combination decongestant-antihistamine, but it is not clear that the children benefit clinically. An evidence-based medicine review suggests that they not be used in children, especially given the increased risk of side effects from these medications in this age group.
The controversy over the utility of decongestants is one that continues. In 2023 the Food and Drug Administration (FDA) began to consider whether Phenylephrine, a commonly available decongestant, should be removed from domestic sales. Eight years previous, in 2015, several professors from the University of Florida had petitioned for this ban based on their research conclusion that the drug produced no positive benefit. While phenylephrine was not deemed dangerous for use, the contention was that consumers were paying for a health benefit that the drug could not deliver.
Many have advocated for alternatives to decongestants. These are available in medical form, such as antihistamines, that will relieve stuffiness but remain safer for the heart. Other decongestants such as nasal sprays can administer treatment to the area where it is desired without, again, having the active medicine come in contact with the heart. There are also less invasive methods to relieve congestion. These include hot showers, breathe strips, and adequate hydration, which tends to dilute mucus.
Bibliography
American Academy of Otolaryngology—Head and Neck Surgery. "Antihistamines, Decongestants, and Cold Remedies." American Academy of Otolaryngology—Head and Neck Surgery, December, 2010.
"Don't Let Decongestants Squeeze Your Heart." Harvard Health Publishing, 11 Apr. 2023, www.health.harvard.edu/heart-health/dont-let-decongestants-squeeze-your-heart. Accessed 4 Aug. 2023.
FamilyDoctor.org. "Decongestants: OTC Relief for Congestion." FamilyDoctor.org, February, 2012.
"FDA Panel to Again Weigh Merit of Decongestant That Many Call Useless."U.S. News and World Report, 6 Mar. 2023, www.usnews.com/news/health-news/articles/2023-03-06/fda-panel-to-again-weigh-merit-of-decongestant-that-many-call-useless. Accessed 4 Aug. 2023.
Flynn, C. A., G. Griffin, and F. Tudiver. “Decongestants and Antihistamines for Acute Otitis Media in Children.” In The Cochrane Library, Issue 4. New York: John Wiley & Sons, 2003.
Komaroff, Anthony, ed. Harvard Medical School Family Health Guide. New York: Free Press, 2005.
Lacy, Charles F. The Drug Information Handbook. 20th ed. Hudson, Ohio: Lexi-Comp, 2011.
Schiff, Donald, and Steven Shelov, eds. American Academy of Pediatrics Guide to Your Child’s Symptoms: The Official, Complete Home Reference, Birth Through Adolescence. New York: Villard, 1999.
Schroeder, K., and T. Fahey. “Over-the-Counter Medications for Acute Cough in Children and Adults in Ambulatory Settings.” In The Cochrane Library, Issue 4. New York: John Wiley & Sons, 2003.
Taverner, D., L. Bickford, and M. Draper. “Nasal Decongestants for the Common Cold.” In The Cochrane Library, Issue 4. New York: John Wiley & Sons, 2003.
Weiss, Cynthia. "Mayo Clinic Q and A: Decongestants Can Sometimes Cause More Harm Than Good." Mayo Clinic, 1 Mar. 2023, newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-decongestants-can-sometimes-cause-more-harm-than-good. Accessed 4 Aug. 2023.