Systemic Nasal Decongestants (Phenylephrine & Pseudoephedrine)

Importance for Asking About Use

Worsening of concomitant conditions, drug interactions, safety concerns.

Dangers of Use

Use of systemic nasal decongestants can increase blood pressure and heart rate. This may worsen cardiovascular conditions such as hypertension, arrhythmias, and heart failure. Since decongestants work by vasoconstriction, conditions such as BPH may be exacerbated. Decongestants may also cause sleep disturbances and agitation. Side effects can be intensified if taken with stimulants. The use of systemic decongestants with MAOIs can be life threatening. Finally, patients with diabetes may experience changes in their blood glucose levels.

Recommendation

Discuss the use of topical decongestants, topical steroids, nasal saline, and nasal strips as alternatives to systemic decongestants. For congestion related to allergic rhinitis, review allergen avoidance measures and consider first generation antihistamines to prevent allergic rhinitis symptoms.


Lucio Volino, PharmD, is a Clinical Assistant Professor in the Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, NJ.

References

  1. Consumer Healthcare Products Association. Statistics on OTC Use. http://www.chpa.org/MarketStats.aspx. Accessed March 2, 2015.
  2. Qato DM, Alexander GC, Conti RM, Johnson M, Schumann P, Lindau ST. Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States. JAMA. 2008;300(24):2867-78.
  3. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent Patterns of Medication Use in the Ambulatory Adult Population of the United States: The Slone Survey. JAMA. 2002;287(3):337-44.