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What are OTC decongestants?

Decongestants are medicines that help relieve a congested (stuffy) nose. The congestion can be caused by a cold virus or by the flu, sinusitis, or allergies. Most decongestants come in pill or liquid form. When you buy decongestants at the store without a prescription, they are called over-the-counter (OTC) medicines.

Decongestant nose sprays and drops are also available over the counter. However, these products shouldn’t be used for more than 3 days. Your body can become dependent on them. If you become dependent on these medicines, your nose may feel even more stuffed up when you quit using them. This is known as the “rebound effect.”

The active ingredient in most decongestants is either phenylephrine or pseudoephedrine.

Is pseudoephedrine safe? Why is it sold behind the counter?

Yes, pseudoephedrine is a safe and effective decongestant when taken as directed. However, some people use OTC pseudoephedrine illegally. They combine it with other products to make methamphetamine (“meth”). Meth is an illegal and dangerous street drug. In Canada products that contain pseudoephedrine as a single ingredient are kept behind the counter.  Pseudoephedrine combination products (example Advil Cold and Sinus) are sold from the self-selection area of the pharmacy that is operated under the direct supervision of the pharmacist. 

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How do decongestants work?

When your body detects a virus, the flu, sinusitis, or allergies, it sends extra blood to the blood vessels in the nose to fight the problem. This leads to swelling of the blood vessels and tissue in your nose. It makes you feel stuffy. It can be hard to breathe through your nose.

Decongestants work by narrowing blood vessels in the lining of the nose. This reduces how much blood flows through the area so that swollen tissue inside the nose shrinks and air can pass through more easily.

How can I safely take OTC decongestants?

Before you take OTC decongestants, read the directions on the drug facts label. It will tell you how much medicine to take and how often to take it. If you have any questions, contact your healthcare provider or pharmacist.

Follow these tips to make sure you are taking the right amount of medicine:

• Take only the amount shown on the medicine’s label. Don’t assume that more medicine will work better or quicker. Taking more than the recommended amount can be dangerous.
• If you are taking a prescription medicine, ask your healthcare provider or pharmacist if it’s okay to also take an OTC decongestant.
• Don’t use more than 1 OTC decongestant medicine at a time unless your healthcare provider says it’s okay. They may have similar active ingredients that add up to be too much medicine.

If using a liquid decongestant, use the measuring spoon that came with the medicine. This spoon is the right size for the dose you need. Don’t use a kitchen spoon.

When using decongestants, keep a record of the OTC medicines you’re using and when you take them.

How can I safely store OTC decongestants?

Store all medicines up and away, out of reach and sight of young children. Keeping medicines in a cool, dry place will help prevent them from becoming less effective before their expiration dates. Do not store medicines in bathrooms or bathroom cabinets. These locations are often hot and humid.

Things to consider

Like any medicine, decongestants can sometimes cause side effects. They can temporarily cause nervousness, dizziness, and sleeping problems. They can cause heart palpitations (the feeling that your heart is racing) or higher blood pressure.  Healthy adults who only use them once in a while usually don’t experience side effects.

If decongestants make you feel restless or make it difficult for you to sleep, you may want to avoid taking them at bedtime.  It also may help to cut back on caffeine you drink while taking this medicine. Or you may need to discontinue the medicine.

Who shouldn’t take decongestants?

Don’t take decongestants if you have high blood pressure that isn’t controlled. Taking decongestants can raise your blood pressure even if it is controlled or nearly normal. You may need to look for an alternative to decongestants.

Contact your healthcare provider or pharmacist before using a decongestant if you have any of the following health problems:

• Diabetes
• Glaucoma
• Heart conditions
• High blood pressure
• Prostate problems
• Thyroid problems

Don’t give decongestants to children younger than 6 years of age. Instead, there are other ways you can treat their symptoms:

• For very young children, use a bulb syringe to remove mucus from their noses.
• Use saline spray or drops to help loosen mucus.
• Use a cool-mist humidifier. Place it in the child’s bedroom. The moisture created by the humidifier will help your child’s nose and throat not feel so dry.

Can OTC decongestants cause problems with any other medicines I take?

Decongestants can interact with many other medicines you take. If you take any of the medicines listed below, contact your healthcare provider or pharmacist before taking a decongestant:

• Diet pills
• Medicines for asthma
• Medicines for high blood pressure

Decongestants are often combined with antihistamines or pain relievers. It’s important to understand each of the active ingredients in combination medicines because they could cause interactions with other medicines. For safest practice, try to avoid combination products that treat many symptoms at once. Only use a combination decongestant if you aren’t taking other medicines that contain the same active ingredients. This will help you avoid taking too much of any 1 ingredient.

When should I contact my healthcare provider?

Contact your healthcare provider if:

• Your congestion lasts more than 2 weeks.
• You have a fever.
• You have severe pain in your face or sinuses.

If you are regularly using an OTC decongestant nasal spray to keep your nose clear, talk with your healthcare provider about other treatments that are safer to use.