Drugs for runny nose, sinus trouble, congestion, and the common cold constitute the largest segment of the over-the-counter market for America’s pharmaceutical industry. When used wisely, they provide welcome relief for at least some of the discomforts that affect almost everyone occasionally and that affect many people chronically. Drugs in these categories are useful for relief of symptoms from allergies, upper respiratory infections (i.e., sinusitis, colds, flu), and vasomotor rhinitis (a chronic stuffy nose caused by such unrelated conditions as emotional stress, thyroid disease, alcohol, pregnancy, and others). These drugs do not cure the allergies, infections, etc.; they only relieve the symptoms, thereby making the patient more comfortable.

Histamine is an important body chemical that is responsible for the congestion, sneezing, and runny nose that a patient suffers with an allergic attack. Antihistamine drugs block the action of histamine, therefore reducing the allergy symptoms. For the best result, antihistamines should be taken before allergic symptoms get well established.

The most bothersome side effect that antihistamines produce is drowsiness. Though desirable at bedtime, it is a nuisance to many people who need to use antihistamines in the daytime. Another possible side effect of antihistamines is weight gain.

Typical antihistamines include Benadryl, Claritin, Allegra, Zyrtec, etc.

Congestion in the nose, sinuses, and chest is due to swollen, expanded, or dilated blood vessels in the membranes of the nose and air passages. These membranes have an abundant supply of blood vessels with a great capacity for expansion (swelling and congestion). Histamine can stimulate these blood vessels to expand.

Decongestants, on the other hand, cause constriction or tightening of the blood vessels in those membranes, which then forces much of the blood out of the membranes so that they shrink, and the air passages open up again.

Decongestants are chemically related to adrenalin, the natural decongestant, which is also a type of stimulant. Therefore, the side effect of decongestants is a jittery or nervous feeling. They can cause difficulty in going to sleep, and they can elevate blood pressure and pulse rate. Decongestants should not be used by a patient who has an irregular heart rhythm (pulse), high blood pressure, heart disease, or glaucoma.

Typical decongestants are phenylephrine (Neo-Synephrine), and pseudoephedrine (Sudafed)

Theoretically, if the side effects could be properly balanced, the sleepiness sometimes caused by antihistamines could be canceled by the stimulation of decongestants. Numerous combinations of antihistamines with decongestants are available: Allegra-D, Clarinex-D, Zyrtec-D, Claritin-D, et cetera.

The types of nose sprays that can be purchased without a prescription usually contain decongestants for direct application to nasal membranes. They can give prompt relief from congestion by constricting blood vessels, but can result in a “rebound” congestion effect, which is very unpleasant and undesirable. If the patient uses the spray again, it starts the cycle again. Spray-decongestion-rebound-and more congestion. This can lead to serious “addiction” problems to nasal sprays such as Afrin and therefore we caution their use and limit it to a few days.

Nasal steroids include Flonase, Nasonex, et cetera. They are used for chronic nasal inflammation and congestion from allergies and other causes. They are the mainstay of symptomatic control of nasal symptoms related to allergies. Other nasal sprays include nasal antihistamines (Astelin, et cetera) which can be used in conjunction with nasal steroids or by themselves for nasal vasomotor rhinitis (runny nose).

Learn more about Michael Bublik, MD.