People who take monoamine oxidase (MAO) inhibitors, have uncontrolled high blood pressure, heart disease, glaucoma, prostate enlargement, or allergy to these agents should avoid decongestants. Many physicians recommend decongestants as a long-term solution for chronic sinusitis. I do not recommend this class of medicines for more than 1 week because
I believe the long-term effects can be dangerous. Decongestants have stimulant-like properties. Often, you might find that while taking decongestants you have a temporary increase in alertness as well as relief from fatigue. This stimulating influence can have an effect on your heart and your sleep patterns and, in men, can affect the prostate. Any use for more than 72 hours should be under the supervision of a physician.
Risks and Side Effects
Some side effects of decongestants are increased blood pressure, increased heart rate, palpitations, nervousness, insomnia, dizziness, tremor, sweating, and rebound congestion with topical nasal agents. Topical decongestants should not be used for more than 2 days at a time to prevent rebound congestion.
Just as with antihistamines, it’s important to read the information on the medicine’s box. Many products contain these two drugs in various combinations with other agents: pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE).
Decongestant Nasal Sprays
OTC nasal sprays may be effective in the short term but will be very harmful in the long term. These popular products appear at first to be effective because they shrink the nasal tissues so that you can breathe more freely. However, after repeated use, the tissues become swollen and rebound. This rebound swelling is actually worse than the original swelling: The product eventually becomes ineffective and your sinus congestion worsens. This condition is called “rhinitis medicamentosa.” In addition, these products can actually irreversibly damage the membranes of the nose and the sinuses. Septal perforation can occur secondary to decongestant nasal spray overuse.
Topical Nasal Decongestants
Tetrahydrozoline (Tyzine, prescription only)
TOPICAL NASAL ANTICHOLINERGIC AGENTS
Anticholinergic products offer temporary relief of runny nose. They work by decreasing nasal secretions and blocking receptor sites that cause mucus production. One anticholinergic agent is ipratropium (Atrovent). Patients who are allergic to the medication ipratropium should not take these products. Side effects include bloody nose, nasal dryness, and nausea.
Mucolytics cause the goblet cells to increase the amount of water in the mucus, which changes the consistency to be thinner and flow more easily. These medications are prescribed for people whose major symptoms are thickened mucus and postnasal drip. They act as expectorants, helping the body loosen mucus by making bronchial secretions thinner and easier to cough up; they do not suppress a cough. These agents are usually an adjunct medication within a broader remedy treatment protocol. One example is guaifenesin (Mucinex and Humibid plain).