Decongestants are medicines used to relieve nasal congestion (stuffy nose), acommon symptom of colds and allergies. Congestion results when membranes lining the nose become swollen. Decongestants relieve this swelling by narrowingblood vessels that supply the nose. This reduces blood supply to the swollenmembranes, causing them to shrink.

These medicines do not cure colds or reverse the effects of histamines--chemicals released as part of the allergic reaction. They relieve only the stuffiness. When considering whether to use a decongestant for cold symptoms, keep in mind that most colds go away with or without treatment and that taking medicine is not the only way to relieve a stuffy nose. Drinking hot tea or brothor eating chicken soup may help.

Decongestants are sold in many forms, including tablets, capsules, caplets, gelcaps, liqui-caps, liquids, nasal sprays, and nose drops. These drugs are sometimes combined with other medicines in cold and allergy products designed to relieve several symptoms. Some decongestant products require a physician'sprescription, such as Claritin and Allegra, but there are also many nonprescription (over-the-counter) products.

Commonly used decongestants include oxymetazoline (Afrin and other brands), phenylpropanolamine, and pseudoephedrine (Sudafed, Actifed, and other brands).

Decongestant nasal sprays and nose drops may cause a problem called rebound congestion if used repeatedly over several days. When this happens, the nose remains stuffy or gets worse with every dose. The only way to stop the cycle is to stop using the drug. The stuffiness should then go away within about a week. Anyone showing signs of severe rebound congestion should see a doctor.

Do not share droppers or spray bottles with anyone else, as this could spreadinfection. Do not let droppers and bottle tips touch countertops or other surfaces.

Some decongestants cause drowsiness. People who take these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drugs affect them.

The decongestant phenylpropanolamine has caused serious side effects, including death, when taken in large amounts. Phenylpropanolamine may interact withcaffeine, causing symptoms that include disorientation, confusion, and talking incoherently. Anyone taking phenylpropanolamine should avoid anything thatcontains caffeine. This includes coffee, tea, cola, chocolate, and many prescription and nonprescription (over-the-counter) medicines. Older people are especially vulnerable to this problem.

In general, older people may be more sensitive to the effects of decongestants and may need to take lower doses. They should not take long-acting (extended release) forms of decongestants unless they have previously taken a short-acting form with no ill effects.

Children may also be more sensitive to the effects of decongestants. Call a physician or poison center immediately if they are given large amounts of these drugs or if they swallow nose drops, nasal spray or eye drops.

Some phenylpropanolamine products also contain the dye tartrazine, which causes an allergic reaction in some people. People who are allergic to aspirin are particularly likely to be allergic to tartrazine.

In studies of laboratory animals, some decongestants have had unwanted effects on fetuses. However, it is not known whether such effects also occur in people. Women who are pregnant or who plan to become pregnant should check withtheir physicians before taking decongestants. Women who take the decongestantphenylpropanolamine after delivery may have mood or mental changes.

Some decongestants pass into breast milk and may have unwanted effects on nursing babies. Women who are breastfeeding should check with their physicians before using decongestants. If they need to take the medicine, it may be necessary to bottle feed the baby with formula.

Anyone with heart or blood vessel disease, high blood pressure, diabetes, enlarged prostate, or overactive thyroid should not take decongestants unless under a physician's supervision. The medicine can increase blood sugar in people with diabetes. It can be especially dangerous in people with high blood pressure, as it may increase blood pressure. Before using decongestants,people with glaucoma or a history of mental illness should make sure their physicians are aware of their conditions.

The most common side effects from decongestant nasal sprays and nose drops are sneezing and temporary burning, stinging, or dryness. These effects are usually temporary and do not need medical attention. If any of the following side effects occur, stop using the drops or spray immediately and call the physician:

  • Increased blood pressure
  • Headache
  • Fast, slow, or fluttery heartbeat
  • Nervousness
  • Dizziness
  • Nausea
  • Sleep problems.

The most common side effects of decongestants taken by mouth are nervousness,restlessness, excitability, dizziness, drowsiness, headache, nausea, weakness, and sleep problems. Anyone who has these symptoms while taking decongestants should stop taking them immediately.

Patients who have any of the following symptoms while taking decongestants should call the doctor immediately:

  • Increased blood pressure
  • Fast, irregular, or fluttery heartbeat
  • Severe headache
  • Tightness or discomfort in the chest
  • Breathing problems
  • Fear or anxiety
  • Hallucinations
  • Trembling or shaking
  • Convulsions (seizures)
  • Pale skin
  • Painful or difficult urination.

Decongestants may interact with a variety of other medicines. Do not take decongestants at the same time as Monoamine oxidase inhibitors (MAO inhibitors)such as phenzeline (Nardil) or tranylcypromine (Parnate), or within two weeksof stopping treatment with an MAO inhibitor unless a physician approves.

Other drugs that may interact with decongestants include:

  • Tricyclic antidepressants such as imipramine (Tofranil) or desipramine (Norpramin)
  • Maprotiline (Ludiomil)
  • Amantadine (Symmetrel)
  • Amphetamines
  • Medicine to relieve asthma or other breathing problems
  • Methylphenidate (Ritalin)
  • Appetite suppressants
  • Othermedicine for colds, sinus problems, hay fever or other allergies
  • Beta blockers such as atenolol (Tenormin) and propranolol (Inderal)
  • Digitalis glycosides, used to treat heart conditions.

Be sure to check with a physician or pharmacist before combining decongestants with any other prescription or nonprescription (over-the-counter) medicine.

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