What Are Decongestants?

Check out this answer from Consensus:

Decongestants can provide modest short-term relief from nasal congestion in adults, particularly when used as a single dose. However, their benefits are limited with repeated use, and they are not recommended for young children. Both oral and topical decongestants have their own sets of advantages and potential drawbacks, and their use should be tailored to the specific needs and conditions of the patient.

Decongestants are a class of medications commonly used to relieve nasal congestion, a prevalent symptom in various upper respiratory conditions such as the common cold, sinusitis, and allergic rhinitis. These medications work by narrowing the blood vessels in the nasal passages, thereby reducing swelling and congestion.

Types of Decongestants

Decongestants are available in two primary forms: oral and topical. Each type has its own set of advantages and disadvantages.

Oral Decongestants

Oral decongestants, such as pseudoephedrine and phenylephrine, are taken by mouth and work systemically to reduce nasal congestion. Pseudoephedrine is generally more effective than phenylephrine, which is subject to first-pass metabolism and thus less bioavailable in recommended doses4. Oral decongestants are less likely to cause rebound congestion, a condition where nasal congestion worsens after the medication wears off, which is more common with topical decongestants4.

Topical Decongestants

Topical decongestants, such as oxymetazoline and xylometazoline, are applied directly to the nasal passages via sprays or drops. These medications provide rapid and intense relief from nasal congestion but have a shorter duration of action. They are also associated with a risk of rebound congestion if used for more than a few days4 9.

Efficacy of Decongestants

The effectiveness of decongestants has been the subject of various studies and meta-analyses.

Common Cold

Several studies have shown that a single dose of nasal decongestant can provide modest short-term relief from nasal congestion in adults suffering from the common cold. For instance, a meta-analysis found a small but statistically significant decrease in subjective symptoms and nasal airway resistance after a single dose of decongestant compared to placebo1 2 5. However, the benefit of repeated doses over several days is minimal1 2 5.

Sinusitis and Other Conditions

The efficacy of decongestants in treating conditions like acute sinusitis in children remains unclear. A systematic review found no evidence to support the use of decongestants, antihistamines, or nasal irrigation in improving symptoms of acute sinusitis in children3. Similarly, the use of decongestant-antihistamine combinations for conditions like otitis media with effusion in children has not shown significant benefits8 10.

Safety and Adverse Effects

Decongestants are generally safe for short-term use in adults, with adverse events being rare and mild. Common side effects include insomnia, especially with pseudoephedrine1 5. However, the safety and efficacy of these medications in children are not well-established, and they are not recommended for use in children younger than 12 years of age with the common cold1 2 5.