Q: I heard pills for sinus congestion don’t work. What should I take to clear my nasal congestion?
Nasal congestion occurs during respiratory infections and allergies, when the body sends white blood cells to the cells in the nose and sinuses, leading to swelling and the creation of mucus. Many people treat congestion with medications called decongestants that temporarily narrow the blood vessels in the nose and sinuses causing the swelling to decrease and the mucus to drain.
Recently, an advisory committee presented information to the U.S. Food and Drug Administration that showed phenylephrine, a popular decongestant in cold and sinus medications is not effective when taken by mouth. At the current dose, too much of the phenylephrine is broken down by the body before it gets to the nose to relieve congestion. For now, cold and sinus tablets containing phenylephrine are still available as we wait for Health Canada to decide on the future availability of these products.
You may have taken a phenylephrine-containing product in the past and experienced symptom relief, but it was likely due to the other medicinal ingredients in the tablet. Allergy medications are often added to relieve congestion and pain relievers such as acetaminophen or ibuprofen are included to relieve the pain caused by pressure buildup in the sinuses.
Pseudoephedrine is a different oral decongestant and can be found behind the counter at the pharmacy as a single-ingredient product or in combination with other medical ingredients in the cough and cold section. A potential drawback for decongestants is that they should not be used by people with heart problems as they may increase heart rate and blood pressure. They can also decrease milk production and should be avoided by people who are breastfeeding. Commonly reported side effects are dizziness, nervousness, a racing heart and trouble falling asleep.
Decongestants are also available in nasal sprays but should only be used for a maximum of three days. When used longer, you can develop rebound congestion where the decongestant causes more inflammation in the nasal passages leading to prolonged symptoms.
Antihistamines are commonly used for allergies and hives but can also be used to treat congestion. They help by temporarily blocking a chemical released by the body called histamine that can be responsible for creating inflammation and mucus. Antihistamines are readily available as single-ingredient products and in combination with decongestants and other medications.
Corticosteroids nasal sprays can improve congestion by reducing local inflammation in the nasal passages. Unlike decongestant sprays, they can be used for a longer duration, which makes them an ideal choice for congestion that occurs during an allergy season as well as with a sinus infection. Dryness and a burning or stinging sensation in the nose are common side effects and can be reduced by using the spray after a shower or after using a nasal saline spray.
Nasal saline sprays help to reduce congestion by moisturizing the nasal passages and thinning mucus so it can drain easier. They can be used several times a day and are generally considered safe for long-term use. Stepping up to a saline nasal irrigation device such as a Neti Pot or a nasal rinse bottle gives added benefit by flushing the nasal passages to physically remove mucus and alleviate congestion. It is recommended to irrigate twice daily and to replace your nasal irrigation device every three months. It is important to only use distilled or sterile water when mixing a saline solution. Although your tap water may be safe to drink, it is not sterile enough for nasal irrigation and could make you very sick.
Remember that a dried-up sinus is hard to drain. Warming up and moistening the nose by taking hot showers, placing warm compresses over the nose, using a humidifier and drinking lots of fluids will all help to clear mucus. If you find sleeping difficult because your congestion is causing you to breathe through your mouth you may find a humidifier in your bedroom beneficial to keep the air warm and moist.
Speaking to your pharmacist about cold, sinus and allergy medications will help you to select the best product based on your medications and medical conditions. If your congestion has lasted more than 10 days or you have severe pain or high fever consult your prescriber for a further assessment.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.