Best for stuffy nose

How to Get Rid of Your Stuffy Nose in Just 15 Minutes

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Pseudoephedrine is a tough product to challenge as a nasal decongestant

“Pseudoephedrine is a proven nasal decongestant, for which there is subjective and objective evidence that it reduces blockage, improves breathing and helps patients feel better. Phenylephrine nasal spray is an effective decongestant, but oral phenylephrine is rapidly metabolised in the gut and there is no evidence of efficacy,” he explains.

Chinese import

Pseudoephedrine treatment is thought to date back thousands of years, and Ephedra sinica — a Himalayan shrub from which ephedrine and its stereoisomer, pseudoephedrine, are derived — was recommended for use in colds, fever and asthma in an early Chinese pharmacopoeia.4

Successful chemical synthesis of pseudoephedrine was reported in the 1920s, although modern commercial production is by yeast fermentation of dextrose in the presence of benzaldehyde.

By the late 1950s, a number of oral formulations of pseudoephedrine were being marketed, and research was starting to suggest that pseudoephedrine was more useful as a nasal decongestant, via its alpha adrenergic vasoconstrictor activity in nasal mucosa, while ephedrine had superior bronchodilator activity via its beta-agonist effects in the airways.
Subsequent research in the 1970s further differentiated the two drugs on the basis of their potential for adverse cardiovascular effects, when it was shown that the dose of pseudoephedrine required to raise diastolic blood pressure above 90mmHg was three times higher than that of ephedrine.5 “Some people liked the stimulant effects of ephedrine, rather like a strong coffee, and it made them feel better. But there were concerns about the cardiovascular and central nervous system effects, so there was a gradual move towards pseudoephedrine in products for nasal congestion,” Professor Eccles explains.

In 1980, a study of pseudoephedrine was published which showed comparable effects of pseudoephedrine 60mg, 120mg and 180mg in reducing the effect of histamine on nasal airway resistance (NAR), all of which were significantly greater than with placebo (P< 0.05).6 Small, but statistically significant increases in pulse and systolic blood pressure occurred after pseudoephedrine 120mg and 180mg, but not after pseudoephedrine 60mg, 30mg or 15mg. So it was concluded that pseudoephedrine 60mg was the optimal single adult dose which achieved maximal nasal decongestion with minimal cardiovascular or other unwanted effects.

More recently, a large, placebo-controlled study of patients with nasal congestion associated with acute upper respiratory tract infection (URTI) showed significantly greater improvement in NAR following single and multiple doses of pseudoephedrine 60mg over three days, with accompanying subjective improvements.7

Pseudoephedrine is not totally free from stimulatory effects on the CNS: sleep disturbance and, rarely, hallucinations have been reported.8

Which combination?

Nasal congestion rarely occurs in isolation — in either allergic rhinitis or common cold sufferers. Antihistamines and intranasal corticosteroids form the mainstay of treatment for allergic rhinitis, with intranasal steroids superior to antihistamines in relieving nasal blockage and most other symptoms.9 Allergy guidelines advise that use of topical decongestants, although more effective than oral agents, should be limited to less than 10 days, owing to potential for local irritation and drug-induced rhinitis.10 However, oral pseudoephedrine alone or combined with newer antihistamines has been shown to relieve nasal congestion in seasonal allergic and perennial rhinitis.11

In cold and influenza remedies, pseudoephedrine has been combined with a wide range of other agents, but an analgesic is almost universal — usually paracetamol.

The additive effect of paracetamol 1,000mg and pseudoephedrine 60mg has been demonstrated in a double blind study in URTI patients.12 Single and multiple doses of the combination provided a greater decongestant effect than either paracetamol or placebo and better pain relief than either pseudoephedrine or placebo.

Professor Eccles, one of the investigators in the study, explains that, although paracetamol caused slight worsening of nasal congestion, pseudoephedrine appeared slightly to enhance the analgesic effects of paracetamol.

“It makes sense to see pseudoephedrine enhancing the analgesic effects because of its slight stimulant properties, in the same way that caffeine can boost the effects of painkillers,” he explains.

Potential for abuse

As all viewers of the cult US television series “Breaking bad” will know, methamphetamine is remarkably easy to make although producing highest quality crystals like those achieved in the programme by chemistry teacher turned drug baron Walter White requires considerable skill. As the latest “World drug report” points out, it is difficult to measure illicit manufacture and use of methamphetamine because of the small-scale, but widespread nature of production.13 As in previous years, the level of amphetamine abuse worldwide in 2010 came second only to cannabis, with estimates ranging from 14 million to 53 million users.13 Global methamphetamine seizures now exceed those of amphetamines, with increases in Central America and South and South East Asia, and criminal gangs operating increasingly through West Africa, in a way similar to cocaine traffickers.13

The widespread limitations introduced on sales of pseudoephedrine followed an increase in methamphetamine use in the US, UK and elsewhere during the early 2000s. But the latest UK Public Assessment Report from the Medicines and Healthcare products Regulatory Agency makes reassuring reading.2 As well as documenting a reduction in pseudoephedrine sales since restrictions were introduced on the amount that can be purchased, the report notes the lack of evidence of widespread methamphetamine use in the UK.2 Professor Eccles points out that the biggest problems are focused on the larger drug factories in Mexico and some US states but believes that some of the media coverage have a political rather than a medical basis.

“Of course it’s tragic when someone dies as a result of substance abuse, but it’s often difficult to know what they were taking. In the US, you see politicians talking about the risks of pseudoephedrine without really knowing the facts and, as a result, we are seeing pseudoephedrine being replaced with phenylephrine in oral products when there really is no good evidence of efficacy,” he says.

Use in sport

For Olympic athletes, the advice about taking oral products containing pseudoephedrine is clear-cut. WADA advises them to stop taking such products 24 hours before in-competition periods. Some experts question the need for pseudoephedrine to be on the banned list at all. It was off the banned list altogether from 2004–09. One recent placebo-controlled study of the effects of pseudoephedrine 2.5mg/kg body weight on the performance of female college athletes failed to show any impact on 800 metre run times.14 But a similar study carried out in 1,500 metre runners did show a 2 per cent reduction in completion time.15

Professor Eccles suggests that the restriction is less to do with performance enhancement and more to do with potential drug test confusion with other substances with similar structures, such as ephedrine and methamphetamine. He concludes that pseudoephedrine is a tough product to challenge as a nasal decongestant.

“In my 40 years in the business, I’ve seen companies spend a lot of money trying to develop new decongestants, but it always come back to safety. You can get efficacy, but when you’re selling in a consumer market, you have to be sure that the vasoconstrictor effects you need for the decongestant aren’t going to cause safety problems elsewhere, such as the kidney. Only pseudoephedrine has been able to strike the right balance and, given that it’s available in multi-symptom products in the oral formulations that patients like, I can’t see it being bettered. Any action to take account of the methamphetamine issue should be proportional, otherwise we will be depriving the general public of a safe and effective oral decongestant.”

1 World Anti-Doping Agency. Prohibited list 2012. Available at (accessed 13 July 2012).
2 Medicines and Healthcare products Regulatory Agency. UK public assessment report. Pseudoephedrine- and ephedrine-containing medicines: 2011 review of actions to manage the risk of misuse August 2011. Available at www.mhra.gov.uk (accessed 13 July 2012).
3 Eccles R. Substitution of phenylephrine for pseudoephedrine as a nasal decongestant. An illogical way to control methamphetamine abuse. British Journal of Clinical Pharmacology 2007;63:10–4.
4 Ravina E. The evolution of drug discovery: from traditional medicines to modern drugs. Germany: Wiley VCH; 2011.
5 Drew CD, Knight GT, Hughes DT et al. Comparison of the effects of D-(-)-ephedrine and L-(+)-pseudoephedrine on the cardiovascular and respiratory systems in man. British Journal of Clinical Pharmacology 1978;6:221–5.
6 Empey DW, Young GA, Letley E et al. Dose-response study of the nasal decongestant and cardiovascular effects of pseudoephedrine. British Journal of Clinical Pharmacology 1980;9:351–8.
7 Eccles R, Jawad MS, Jawad SS et al. Efficacy and safety of single and multiple doses of pseudoephedrine in the treatment of nasal congestion associated with common cold. American Journal Rhinology 2005;19:25–31.
8 E-Medicines Compendium. Sudafed decongestant tablets. Available at: www.medicines.org.uk (accessed 13 July 2012).
9 Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ 1998;317:1624–9.
10 van Cauwenberge P, Bachert C, Passalacqua G, et al. Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology. Allergy. 2000;55:116–34.
11 Meltzer EO, Caballero F, Fromer LM et al. Treatment of congestion in upper respiratory diseases. International Journal of General Medicine 2010;3:69–91.
12 Eccles R, Jawad M, Jawad S et al. Efficacy of a paracetamol-pseudoephedrine combination for treatment of nasal congestion and pain-related symptoms in upper respiratory tract infection. Current Medical Research and Opinion 2006;22:2411–8.
13 United Nations Office on Drugs and Crime. World Drug Report 2012.
14 Berry C, Wagner DR. Effect of Pseudoephedrine on 800 M run times of female collegiate track athletes. International Journal of Sports Physiology and Performance 29 November 2011 .
15 Hodges K, Hancock S, Currell K et al. Pseudoephedrine enhances performance in 1500-m runners. Medicine and Science in Sports and Exercise 2006;38:329–33.

Decongestants

Decongestants are medicines that relieve congestion by reducing swelling, inflammation and mucus formation within the nasal passages or the eye. They have no other effect on symptoms such as a runny nose or sneezing.

Decongestants may be taken orally to help relieve congestion that is affecting the nose, sinuses, and eyes or sprayed directly in the nose or instilled in the eye for a more local effect.

The inside of the nose is lined with small blood vessels. Blood flow is increased to these blood vessels when our immune system detects the presence of an allergen (such as a virus or pollen). This causes swelling within the blood vessels which can block the nasal passageway, making nasal inhalation difficult. In addition, mucous glands within the nose secrete more mucus to trap the allergen which also contributes to nasal congestion and creates a sensation of “stuffiness”.

Most decongestants work by activating alpha-adrenergic receptors either by binding directly to them or stimulating the release of norepinephrine, a chemical transmitter. Activation of these receptors causes vasoconstriction (a narrowing of the blood vessels within that area). This decreases blood flow and helps to shrink swollen tissue, relieving congestion. They are often used in combination with antihistamines.

Decongestants are available as nose drops or nasal sprays, eye drops, and as tablets, capsules, and syrup.

What are decongestants used for?

Decongestants are typically used for conditions associated with nasal or eye congestion, such as:

  • a cold
  • allergies
  • hay fever
  • rhinitis
  • sinusitis.

Decongestants only provide short-term relief from congestion and do not cure the underlying cause or condition.

What are the differences between decongestants?

Decongestants differ by their duration of action, their formulation availability and their propensity for side effects. Federal regulations require that pseudoephedrine is sold behind the pharmacy or service counter because it can be used illegally to manufacture methamphetamine.

Nasal decongestants are usually either short-acting (3 to 4 hours), such as levmetamfetamine or phenylephrine, or long-acting (8 to 12 hours) such as xylometazoline and oxymetazoline.

Topical decongestants (such as xylometazoline or oxymetazoline) have a more rapid onset of action and stronger effect than oral decongestants. They are less likely to cause side effects although there have been rare reports of seizures in children.

Oral decongestants do not cause rebound congestion (see “Are decongestants safe?”, below), but they are not as effective as topical formulations.

Generic name Brand name examples
Levmetamfetamine nasal 1st Aid Vaporizing Inhaler
naphazoline nasal Privine
naphazoline opthalmic Albalon
oxymetazoline nasal Afrin
oxymetazoline opthalmic Visine LR
phenylephrine Nasop, Sudafed PE
phenylpropanolamine Discontinued
propylhexedrine Benzedrex Inhaler
pseudoephedrine Nasofed, Sudafed
xylometazoline Triaminic decongestant

Are decongestants safe?

There are surprisingly few good quality studies that have investigated the effectiveness of decongestants or reported on adverse effects. Most studies excluded children, therefore, most experts recommend not giving decongestants to children under the age of 12 because their effectiveness and risk of side effects is unknown.

Some decongestants (such as pseudoephedrine) have been associated with heart-related side effects such as elevated blood pressure, palpitations, tachycardia. Because decongestants act on alpha adrenoreceptors which are also located in other areas of the body, they may increase intraocular pressure in the eye and aggravate urinary obstruction.

Using nasal decongestants regularly and for longer than three to five days has been associated with rebound congestion. This is when nasal congestion recurs almost immediately once you stop using the decongestant, prompting repeat use of the nasal decongestant. If use continues unabated, a form of rhinitis called rhinitis medicamentosa will develop, which is very difficult to treat.

In some people, even recommended dosages of decongestants can aggravate already high blood pressure or cause heart palpitations or a fast heartbeat. Decongestants may also produce side effects such as CNS stimulation and may not be suitable for people including those with heart disease, high blood pressure, urinary problems, or taking certain medications (such as monoamine oxidase inhibitors).

If taken in overdose, decongestants can cause kidney failure, psychotic symptoms, strokes, and seizures.

What are the side effects of decongestants?

Insomnia and irritability are the most common side effects of oral decongestants and these side effects can occur in up to 25% of people taking these medicines. Other side effects may include:

  • dizziness
  • a headache
  • excitability
  • nervousness
  • tremors.

For a complete list of side effects, please refer to the individual drug monographs.

The single most effective way to unclog your nose

  • Cold and flu season is fast approaching.
  • Break out the antibacterial gel.
  • You’re unlikely to avoid getting ill altogether, so here are a couple of techniques to try if you get a blocked nose.

It’s coming up to that time of year where everyone in your office is going to have the sniffles. No amount of hand gel or avoiding the communal kettle will stop the cold virus getting you — there’s just too many germs around.

If you do get struck down with a cold, one of the most annoying symptoms is a blocked nose. It can linger around even when you feel better, and it feels like you spend most of your weekly budget on tissues.

Rather than endlessly blowing your nose (which you’re probably doing wrong anyway), there are a few techniques for clearing a blocked nose you can try.

According to Prevention magazine, there is one superior method. In a video, the health site explains the tongue tap technique. First, you press your tongue to the top of your mouth and then press between your eyebrows on your forehead. Press, tap, and release for about 20 seconds.

“What it does is it rocks a bone called the vomer bone back and forth, and it actually clears everything that’s congested,” said Amy Rushlow, the managing editor of Prevention.

You can also try putting your head back and pinching your nose, then holding your breath for as long as you can. Take a breath when you finally have to, and your sinuses should be clear.

“Your brain realises that you’re not getting in enough oxygen, so your survival mechanism kicks in, clearing your sinuses so you can get in air,” said Rushlow.

You can watch the whole video below.

There are a few other tried and tested methods to clear a blocked nose on Medical News today. They include:

  • Taking a hot shower — The steam from the shower may help drain mucus away, although it’s just a temporary fix.
  • Flush out the sinuses with neti pots — They have been used for hundreds of years to clear nasal passages of mucus.
  • Eucalyptus oil — Place a few drops of the oil into a cup of boiling water and inhale the steam.
  • Try a decongestant — They are available over the counter and work by narrowing the small blood vessels in the nose, which reduces swelling.

Stuffy or runny nose – adult

Finding ways to keep mucus thin will help it drain from your nose and sinuses and relieve your symptoms. Drinking plenty of clear fluids is one way to do this. You can also:

  • Apply a warm, moist washcloth to your face several times a day.
  • Inhale steam 2 to 4 times a day. One way to do this is to sit in the bathroom with the shower running. Do not inhale hot steam.
  • Use a vaporizer or humidifier.

A nasal wash can help remove mucus from your nose.

  • You can buy a saline spray at a drugstore or make one at home. To make one, use 1 cup (240 milliliters) of warm water, 1/2 teaspoon (3 grams) of salt, and a pinch of baking soda.
  • Use gentle saline nasal sprays 3 to 4 times per day.

Congestion is often worse when lying down. Keep upright, or at least keep the head elevated.

Some stores sell adhesive strips that can be placed on the nose. These help widen the nostrils, making breathing easier.

Medicines you can buy at the store without a prescription can help your symptoms.

  • Decongestants are drugs that shrink and dry up your nasal passages. They may help dry up a runny or stuffy nose.
  • Antihistamines are drugs that treat allergy symptoms. Some antihistamines make you drowsy so use with care.
  • Nasal sprays can relieve stuffiness. Don’t use over-the-counter nasal sprays more often than 3 days on and 3 days off, unless told to by your health care provider.

Many cough, allergy, and cold medicines you buy have more than one medicine inside. Read the labels carefully to make sure you don’t take too much of any one medicine. Ask your provider which cold medicines are safe for you.

If you have allergies:

  • Your provider may also prescribe nasal sprays that treat allergy symptoms.
  • Learn how to avoid triggers that make allergies worse.

How to Stop a Runny Nose Associated with Cold or Allergies

Got a case of the sniffles? Chances are that your nose is running faster than a waterfall. But what is a runny nose exactly? A runny nose is a nasal discharge of mucus. Your doctor might use the term “rhinorrhea” to diagnose your runny nose. “Rhino” is a Greek prefix meaning, “nose,” and “rrhea” means “flow” or “discharge.” A runny nose is the result of excess nasal mucus production, leading to watery nasal secretions that discharge from the nostrils or drip down into the throat. While a cold or the flu is often the culprit, a runny nose can also be the result of allergies. There are simple steps you can take to feel better fast. Here are some smart ways to stop a runny nose:

Drink plenty of fluids

Sipping lots of water and clear chicken broth will help thin your mucus and allow it to drain faster from your nose and sinuses. Drinking hot tea or milk can also have a soothing, warming effect.

Get plenty of rest

When you’re not feeling well, it’s crucial to get plenty of sleep so your body can heal. Plus, resting will give you a much-needed break from blowing your nose!

Apply a warm compress

Putting a warm compress over your nose and forehead can help relieve sinus pressure and congestion. If you don’t have a compress, try moistening a washcloth with warm water and applying it to your face several times a day. This will help relieve nasal congestion and help stop your runny nose.

Get steamy

The next time you have a stuffy nose, try sitting in the bathroom with the shower running. You can also breathe in steam from a bowl of hot water. Inhaling warm (not hot) steam can help soothe the mucous membranes lining the nose.

Use a humidifier

A clean humidifier or cool mist vaporizer is a great way to add moisture back into your environment. Doing so will help keep your nasal passages moist, allowing mucus to drain faster. In other words, you’ll get rid of your runny nose faster.

Try a saline nasal spray or drops

Using a gentle saline nasal spray, or drops three to four times a day can help stop a runny nose and make it easier to breathe. The saline solution will help soothe the mucous membranes inside the nose.

Use the right OTC meds

Non-prescription medications can help ease your symptoms. Although Vicks products can’t cure a runny nose, they can help you feel better until it clears up on its own. Cold medicines, like NyQuil SEVERE, will help dry up your nasal passages—and help relieve your runny nose.For cold symptoms and runny nose at night, try which can dry up your runny nose and calm your cough so you can get the rest you need.

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