Sudafed and benadryl together

Don’t let decongestants squeeze your heart

As many over-the-counter decongestants get a new ingredient, you might want to look for alternatives.

Updated: April 3, 2019Published: March, 2014

For nasal congestion due to colds and allergies, millions of Americans reach for an over-the-counter decongestant to clear a stuffy nose. Some read the warning label: “Do not use this product if you have heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland unless directed by a doctor.” Few heed it.

But it might be good to pay attention to the decongestant’s warning. Many of your favorite products containing a decongestant are no longer so easily available on pharmacy shelves. Others are getting an ingredient makeover.

These changes were part of a national effort to close down home-based “meth labs” that churn out methamphetamine, a highly addictive street drug that is easily made from pseudoephedrine, the active ingredient in Sudafed and many other non-prescription decongestants. Products containing pseudoephedrine now are purchased “behind the counter.” You don’t need a prescription, but you do have to ask a pharmacist or clerk for them and show an ID or sign a log.

Fearing that customers will shy away from asking a pharmacist or clerk for these products, some drug companies are replacing pseudoephedrine with a another over-the-counter decongestant called phenylephrine that can’t be made into methamphetamine.

Is phenylephrine just like pseudoephedrine? Regarding its effectiveness as a treatment for nasal congestion, the answer is no. In fact, some research has found that at the current recommended doses of phenylephrine it offers minimal symptom improvement. It probably is safer for people with high blood pressure and heart disease, but there is not enough research to be certain.

Decongestant effects beyond the nose

A stuffy nose is a hallmark of the common cold and allergic rhinitis. Chalk this symptom up to the body’s immune response.

When you have a cold, virus-infected cells in the nose, sinuses, and throat attract a flood of white blood cells. These infection fighters churn out substances that kill the cold virus but also swell nasal membranes and make the body produce extra mucus.

In allergic rhinitis, the immune cells trigger the same type of response in the nose, sinuses and throat.

Pseudoephedrine constricts blood vessels in the nose and sinuses. This shrinks swelling and drains fluids, letting you breathe easier again. Unfortunately, the drug doesn’t affect only the head — it tightens blood vessels throughout the body.

One effect is a possible increase in blood pressure. In general, this increase is minimal, even in people with controlled high blood pressure, according to a review of 24 trials of pseudoephedrine and blood pressure published in the August 8/22, 2005, Archives of Internal Medicine.

Not everyone is average. Among the people who took part in these studies, about 3% had marked increases in blood pressure.

The FDA says that pseudoephedrine is safe when taken as directed. Indeed, millions of people use it each year without any dire consequences. That doesn’t mean it’s risk free. Over the years, there have been reports of heart attacks, strokes, disturbed heart rhythms, and other cardiovascular problems linked with use of pseudoephedrine.

Alternatives to decongestants

Alternatives to oral decongestants are available. In the drug realm, antihistamines such as diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), cetirizine (Zyrtec), and loratadine (Claritin) can help with a stuffy nose are safe for the heart.

Nasal sprays deliver a decongestant right where you need it. In theory, this should minimize cardiovascular effects. However, nasal decongestant sprays should be used only for several days because it can lead to rebound nasal congestion..

If you want to avoid medications altogether, you can try a variety of things to clear your head. Breathe Right nasal strips may help you breathe better at night. A steamy shower or a hot towel wrapped around the face can relieve congestion. Drinking plenty of fluids, especially hot beverages, keeps mucus moist and flowing. Some people swear by spicy foods, and we would be remiss if we did not mention chicken soup.

Photo: spukkato/iStock/Getty images Plus

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Spring is in the air. Warmer temperatures mean that trees bud, flowers bloom, grass grows and animals get more active. People do, too. But for some of us, spring means handfuls of tissues and a heavy dose of misery in the form of sneezing, watery eyes and stuffy noses. Here are a few tips to help allergy sufferers enjoy the beautiful spring weather:

Oral allergy medications.

Oral medications are especially useful for mild allergy symptoms, and many are available over the counter. Non-sedating antihistamines can relieve itching, sneezing, runny nose and watery eyes.

  • Loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra) are all available without prescription.
  • Oral decongestants, like pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) can ease stuffiness, and pseudoephedrine is often combined with an antihistamine. These medications are generally well tolerated, with minimal side effects.

Common side effects.

Oral decongestants cause insomnia and elevated blood pressure for some people, and antihistamines can cause drowsiness. If you find that one brand of antihistamine makes you sleepy, try a different one to see if you tolerate that better.

Older antihistamines like diphenhydramine (Benadryl) are more likely to cause drowsiness compared to the newer antihistamines. Be careful about driving or working around heavy machinery if you take diphenhydramine.

Nasal steroid sprays.

For more persistent allergy symptoms, nasal steroid sprays are often the best treatment option. Nasal steroid sprays block inflammation and swelling caused by airborne irritants and allergens, and prevent allergy symptoms. Over-the-counter steroid nasal sprays currently available include:

  • Triamcinolone (Nasacort)
  • Fluticasone (Flonase)
  • Budesonide (Rhinocort)

These medications usually start working after a few days. They can take a few weeks to reach peak effect, so they work best when used consistently, at least during your allergy season. It is fine to combine nasal steroid sprays with oral antihistamines, but the nasal steroid spray can prevent excess histamine production when it works well.

Be careful not to confuse nasal steroid sprays with decongestant nasal sprays, such as oxymetazoline (Afrin). Afrin-type sprays work very well for rapid relief of severe nasal congestion, but they are addictive and can actually worsen nasal congestion when used too long. This type of nasal spray should not be used for more than three days in a row.

Eye drops.

Over-the-counter antihistamine eye drops, such as ketotifen, can rapidly relieve itchy eyes. Eye drops are often more soothing when refrigerated. Oral antihistamines and nasal steroid sprays can help itchy eyes eventually, but antihistamine eye drops often provide the most rapid relief.

Inhalers.

If you have asthma along with your allergies, inhaled medications will likely be an important part of your treatment plan. Some inhalers suppress the lung inflammation that causes asthma. Other inhalers, such as albuterol, dilate your airways for temporary relief of asthma symptoms.

Allergy shots.

If you find that “first-line” treatments like nasal sprays and oral medications are ineffective or poorly tolerated, a series of shots to combat allergic symptoms is available. However, you may first want to consider the following:

  • Allergy shots take months to start working and require a large time commitment, but their effectiveness is well documented.
  • Allergy shots contain miniscule amounts of the proteins that cause your allergic symptoms.
  • The shots are administered in gradually-increasing doses once or twice per week for the first few months, then once per month for three to five years.

Visit with your health care provider about these and other ways to combat seasonal allergies and you’ll be able to enjoy all the pleasures this season has to offer. Go for a bike ride, take a hike or picnic with friends. Treat yourself right, and you can leave the tissues at home.

Richard Crockett, M.D., is an allergist with Mayo Clinic Health System in Mankato.

Getting a stuffy nose isn’t just a cold weather thing. During all four seasons, allergens, bacteria, and viruses can inflame the blood vessels in the nose, leaving the nasal passages swollen and obstructed, explains Judy Tung, MD, an internist at NewYork-Presbyterian.

Plenty of over-the-counter medications and natural remedies can help you breathe freely again. But, before you reach for your old standbys, take a second to consider your symptoms, advises Dr. Tung. If mucus is drip, drip, dripping away, like a sink that won’t stop running, you need something that will turn down (or turn off) that dripping faucet, she says. But if your nose is thoroughly clogged, you’ll need something with Drano-like power to clear your nasal passageway. Breathe easy with the best solutions both set of symptoms.

If you have a runny nose…

Try an antihistamine

A runny nose accompanied by itchy eyes is almost always indicates allergies, which typically respond well to antihistamines, says Kristine Arthur, MD, an internist at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

Antihistamines work by blocking the effects of histamine, the chemical the body makes to protect itself from allergens. When histamine is released, it binds to cells in the throat and nose, causing them to swell and leak fluid. This results in a runny nose, sneezing, and itchy eyes.

Antihistamines come in two variants: sedative and non-sedative. Sedating options are most powerful, says Dr. Tung. She typically recommends that her patients take Benadryl (diphenhydramine) at bedtime to stop that faucet-running sensation. During the day, when sleepiness isn’t an option, allergy sufferers can turn to other, less sedating antihistamines: Claritin (loratadine), Allegra (fexofenadine), and Zyrtec (Cetirizine), which are all available over the counter. Claritin is the least powerful—but also least sedating—while Zyrtec is more effective, but might cause a bit of drowsiness, Dr. Tung says.

If you have symptoms for more than a week, see your doctor. It’s possible you have a sinus infection and may need prescription medication.

⚠️ Some medication interactions may cause dangerous side effects ⚠️

Always check with a doctor or pharmacist before using more than two over-the-counter allergy medications, or mixing an allergy medication with prescription medication.

Consider nasal irrigation or a nasal spray

If oral medication isn’t cutting it, nasal irrigation or a nasal spray are definitely worth a shot. Over-the-counter nasal steroid spray like Flonase can help relieve a runny nose and sneezing, and itchy, watery eyes by reducing swelling in the nose, which can lead to classic allergy symptoms, including a runny nose.

Nasal rinses and neti pots, on the other hand, help break up and remove mucus in the nasal passages using a saltwater solution, Dr. Tung explains. This technique can also help flush out debris, allergens, and air pollutants that could be causing your symptoms.

Clean your home with a HEPA vacuum

While keeping a super clean home may seem like a great way to get your allergies under control, if you’re cleaning your house with a standard vacuum you’re likely kicking all the allergens you’re trying to suction. Only vacuums with HEPA (high-efficiency particulate air) filters catch the super tiny particles that make your nose runny and your eyes itchy. Pick up one of these best HEPA vacuums for allergy sufferers to keep pesky pollen and other agitating debris out of your home and out of your nose.

If your nose is totally clogged…

Pop a decongestant

Completely stuffed up and congested? You may have a sinus infection, common cold, or allergies.

If you think you have a cold, a pseudoephedrine-based product like Sudafed may be a good solution (you don’t need a prescription for it, but you do need to ask a pharmacist for it). If you think allergies or a sinus infection are to blame, an antihistamine/decongestant combination like such as Claritin-D, Allegra-D, or Zyrtec-D can help improve your symptoms (the “D” stands for decongestant).

“A decongestant is a powerful nasal constrictor that crunches down on those blood vessels, effectively decreasing the flow of blood and secretions into the area, which gives the body a chance to decongest,” Dr. Tung explains.

If your symptoms last more than a week, check in with your doctor. You could have an infection that requires prescription medication.

⚠️ Check with your doctor before taking pseudoephedrine ⚠️

Pseudoephedrine can raise blood pressure and cause abnormal heart rhythms. If you have a history of cardiovascular health issues, check with your doctor before taking the medication.

Try a decongestant nasal spray

While Flonase is an allergy relief nasal spray, similar looking products like Afrin or Vicks Sinex (oxymetazoline) are better equipped to treat nasal congestion brought on by the common cold and other causes. But use these products cautiously. While they may clear out your stuffy nose at first, using the medication for more than three days can cause the blood vessels to clamp down, leaving you more congested, Dr. Tung cautions.

Get steamy

Be it ever so humble, a hot shower can work wonders on a clogged nose. For best results, Follow Dr. Tung’s step-by-step instructions:

  1. Turn the shower on blazing hot, and let the water run until the bathroom stall is full of fog and steam.
  2. Lower the temperature—so you won’t get scalded—and get in the shower for 15 to 20 minutes.
  3. Keep your face below the showerhead so you can breathe in the steam, which will loosen up the mucus.
  4. Toward the end of your shower, hack, spit, sneeze, and cough to get all the mucus and phlegm out of your system.

“Usually you’ll feel almost back to normal for a couple of hours ,” Dr. Tung says. It’s not a permanent solution—the mucus will build up again—but for a precious period, you’ll be able to breathe clear, and step away from the tissues.

Can’t take a steamy hot shower every few hours? Apply a washcloth over your face or run a humidifier (like one of these top-rated picks) or vaporizer can help get the mucus out.

Madeleine Burry Madeleine Burry is the former associate managing editor for Parents.com, and is currently a freelance writer, editor, and content strategist, with work appearing in Women’s Health, Health.com, and other online publications.

In the past, whenever I’ve come down with a cold, I’ve usually reached for one of those all-in-one cold drugs or a decongestant and some Tylenol.

But Jennifer Ackerman, author of a new book on the common cold called Ah-Choo!: The Uncommon Life of Your Common Cold, argues that’s not the way to go at all.

In an interview with NPR’s Fresh Air, Ackerman said that, after all the research she did for her book, her treatment of choice for the common cold is now ibuprofen (Advil, Motrin) and a “first-generation”, sedating allergy drug like Benadryl or Chlor-Tripolon.

Ackerman bases her self-treatment regimen largely on the advice of Jack Gwaltney, one of the leading experts on the cold.

One of the reasons Benadryl plus Advil works, Ackerman says, is because of the weird way in which the cold virus behaves.

Unlike the flu virus, which actively damages human cells, cold viruses don’t actually do much direct damage to our body. Most of the symptoms we experience are, instead, a result of our immune system’s over-reaction to the virus — much like with allergies.

Allergy drugs like Benadryl tamp down our body’s natural immune response to the cold virus, giving us some relief. But it’s important to use an older, “first-generation” allergy drug like Benadryl, says Ackerman, because newer allergy drugs like Claritin don’t have the same effect on cold symptoms.

Unluckily, I got a chance to test Ackerman’s theory for myself a few days ago after coming down with a nasty head cold.

I picked up some store brand ibuprofen and allergy meds and gave them a try instead of my usual routine. (A quick cost-saving note: There are plenty of store brand versions of Benadryl. Just look for pills that contain Diphenhydramine hydrochloride, the active ingredient in Benadryl.)

I must admit, I was a bit skeptical at first — in part because Benadryl (and its store-brand versions) isn’t marketed as a cold remedy.

Overall, though, the Benadryl/Advil combo seemed to do a good job of getting rid of that tickle in my nose, reduced my sneezing more than my usual medication routine and made me feel a bit better. One negative, however, is that Benadryl — unlike the newer allergy meds — makes you drowsy, so I felt a bit out of it.

After checking out cold expert Jack Gwaltney’s own website, I see he advises adding a decongestant to the medication mix if the anti-allergy meds alone don’t get rid of your nasal congestion — which is something I might now try.

A quick word of warning: These are treatments for adults, not children. Only give your kids drugs that are approved for children.

While Ackerman believes drugs like Benadryl can provide some relief for colds, she says there’s no evidence to suggest that other cold remedies — like echinacea, Vitamin C or zinc lozenges — do much good.

First, there’s little evidence such remedies actually “boost your immune system” as they claim. And as Ackerman explains in this New York Times piece, even if they were immune-boosters, that wouldn’t help because it’s your body’s immune system that is making you feel miserable in the first place:

It seems counterintuitive, but there it is: People with more active immune systems may be especially prone to cold symptoms. So getting a cold may be a positive sign that your biochemical defenses are working normally — a glass-half-full view of getting the sniffles.

Ackerman also isn’t a fan of all-in-one cold medications (like the ones I used to take), because they include a number of different active ingredients instead of being targeted at specific symptoms. There’s also a concern such drugs can lead to overdoses because people sometimes take a cold drug and then take some Tylenol (acetaminophen), not realizing that the cold drug itself contained acetaminophen.

As for avoiding getting a cold in the first place, Ackerman says the best advice is still to wash your hands regularly.

Most of us get colds, she says, because we touch a surface that has the virus on it and then touch our face, delivering the virus directly into our bodies. While not touching your face would help, too, Ackerman said this is a lot harder than people think — most of us touch our face one to three times every five minutes. So hand-washing is the best way to go.

What about you? What do you do to avoid getting a cold? And what treatments do you use to reduce your symptoms when a cold hits? Post a comment and let me know.

And be sure to check out my earlier post on whether parents of small children get sick more often.

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