Decongestant not working? Here's how to choose the right one.

Over-the-counter cold and flu remedies, including decongestant medications, herbal supplements, and home remedies to alleviate symptoms and provide relief during the cold and flu season.What's the first thing you do when cold or allergy symptoms start creeping their way into your sinuses? If you're among the 81% of Americans who reach for over-the-counter medicine, you might want to rethink your relief options.

You may have already noticed a lack of decongesting power behind your favorite cold and flu pills. Or maybe you saw the news that an FDA advisory committee found popular decongestants aren't effective when taken orally. While this information may be overwhelming for sufferers, it doesn't have to feel like the end of the road.

Why isn't medicine helping my congestion?

If OTC decongestant cold and flu tablets aren't doing the trick, the active ingredient phenylephrine may be to blame.

A 2023 panel determined that the recommended dosage of orally-administered phenylephrine as a nasal decongestant cannot be supported by current scientific data. While not dangerous, the ineffectiveness of this ingredient undercuts the relief that can be provided by certain formulations of popular brands like Tylenol, Sudafed and Dayquil. These findings may lead sufferers to ask "Does phenylephrine work?", but there remains strong evidence to support its use when administered nasally.

Consider treating blocked sinuses at the source, so you don't have to worry about your oral decongestant not working.

What is the best medicine to relieve nasal congestion?

No matter the cold or allergy season, people with stuffy noses just want to breathe easier. And sometimes, relieving this one symptom can make a significant difference. While there is no one-size-fits-all approach, the best medicine for sinus congestion relies on your individual needs.

Young woman seated on a couch, blowing her nose into a facial tissue. Background includes allergy, cold, and flu pills, nasal spray, and a thermometer. Image features solutions to relieve nasal congestion for allergy, cold, and flu symptoms.

Nasal decongestant sprays

Don't get the science twisted — if your trusty Sudafed isn't working, it doesn't mean phenylephrine doesn't work as a decongestant. While the body breaks down too much of the drug to be effective in current pill formulations, delivering the drug directly to the nose via nasal spray formulation treats the affected area at the source.

Decongestant nasal spray for cold and allergy-related congestion may contain ingredients like:

  • Phenylephrine
  • Oxymetazoline
  • Pseudoephedrine

In an acute setting, a nasal spray for congestion can work wonders for a stuffy nose — so long as you follow usage instructions. Experts strongly advise against using them for longer than a few days, as there can be serious side effects with prolonged use. Decongestants can also interact with certain asthma medications, diet pills, blood pressure medications and antidepressants.

Misusing or overusing nasal decongestant sprays can lead to:

  • Rebound congestion
  • Heart palpitations
  • Dizziness
  • Trouble sleeping
  • High blood pressure

Nasal steroid sprays and antihistamines

While a decongestant may seem like the obvious choice, it may not be the best nasal spray for allergies. In chronic cases, experts try to steer patients towards safer treatment options to avoid the effects on blood pressure.

Decongestants constrict the blood vessels in the nose to reduce swelling, while antihistamine nasal sprays block the body's inflammatory response to allergens to prevent congestion. Certain oral formulations can also be used as sleep aids and to treat common cold symptoms.

Nasal steroid sprays containing drugs like fluticasone (the active ingredient in Flonase) are a safe option to use regularly. While these sprays can provide relief when needed, regular use is recommended for optimal results. Try using a powered tool like a nasal nebulizer to deliver liquid medication, so medication reaches problem areas deep in the sinuses.

Natural nasal decongestant sprays

Some sufferers may take comfort in remedies formulated with familiar ingredients like essential oils and xylitol. These continue to be researched as treatment options for chronic rhinosinusitis and perennial allergic rhinitis.

Nasal saline and nasal hygiene

When it comes to improving nasal symptoms, saline nasal rinses are tried and true. While it may not be the first choice for sufferers who choose oral remedies, there is evidence to suggest that consistent nasal irrigation may reduce the use of decongestants.

Practicing daily nasal hygiene can be as simple as using a saline nose spray to clear irritants, allergens, and bacteria from the nasal passages.

'Dos and Don'ts of Oral Decongestants.' Learn proper usage and precautions for effective nasal congestion relief.

What to do when decongestants don't work

Over-the-counter medicine may make treatment seem simple, but finding real relief can be much more complicated. While hundreds of medications are readily available on drugstore shelves, they don't come without risks.

Whether you've tried pills, syrups or sprays, if decongestants aren't working, talk to a healthcare provider first. Combining medications, herbal remedies, and even certain foods can be harmful for your health. Misusing or overusing medication could even send you to the emergency room.

Consider seeking the advice of a specialist to relieve sinus symptoms. An ENT, allergist or rhinologist can diagnose structural issues or sinonasal disease that may be causing chronic symptoms, while your local compounding pharmacist can provide guidance on the best over-the-counter medications and create formulas tailored to your needs.

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