Nasal decongestants (systemic)

Decongestants may contain pseudoephedrine, phenylephrine, oxymetazoline or xylometazoline.

Nasal decongestants are available as systemic (oral) nasal decongestants (liquid or tablets) or topical decongestants (nasal sprays or drops) (1)

• are mostly available over‐the‐counter without restrictions
• is recommended that they should not be given to children under the age of six years
• due to the risk of rebound congestion after stopping use of decongestants it is advised that people should not use a decongestant for longer than five days
• nasal decongestants mainly act locally but there may be systemic effects, such as hypertension.
  • other common side effects include headache, nausea, insomnia and dizziness

Oral decongestants (2)

• oral decongestants influence the physiology of cardiovascular, urinary, central nervous and endocrine systems, and an overdose significantly increases the blood pressure and stimulates the central nervous system
• possible side effects of oral decongestants include:
  • hypertension
  • myocardial ischaemia
  • arrhythmia
  • tachycardia
  • endocrine and metabolic dysregulation
• are not recommended to allergic rhinitis patients with hypertension, myocardial ischaemia, arrhythmias, or tachycardia
• should be cautiously applied to patients with thyroid disease, diabetes mellitus, and other endocrine or metabolic disorders
• in children, decongestants may cause nausea, vomiting, drowsiness, tachycardia, decreased respiration, bradycardia, hypotension, hypertension, sedation, dilated pupils, coma, hypothermia, and drooling, and severe cases even need to be hospitalized

Reference:

1. Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612.
2. Wang J et al. Rise and fall of decongestants in treating nasal congestion related diseases. Expert Opinion on Pharmacotherapy 2024; 25(14):1943–1951.