Topical decongestants are wonderful symptom relievers. Afrin (Oxymetozoline) is the “gold standard” in topical decongestion. We generally have our patients use two to three sprays in each nostril for three days to initiate therapy. This is extremely effective in facilitating drainage as well as breathing. Neosynephrine is also available, but it seems to have more systemic side effects such as tachycardia and hypertension.
If topical decongestants are used too frequently, patients risk developing “rebound congestion”. This side effect makes many patients dependent on chronic use just to breathe normally. This is why nose sprays should be reserved for emergency and short-term use. However, they can be safely used for several days before rebound effects occur.
Systemic decongestants such as pseudophedrine or phenylpropanolamine are also good adjuncts to open up the sinonasal passages and lessen secretions. However, they do have side effects that should be considered. Any time you see a product with the suffix -D (such as Claritin-D, Allegra-D, Zyrtec-D, etc.), that means it is combined with a systemic decongestant.
We typically start patients on 30 to 60 mg of pseudophedrine every four to six hours. Note that pharmacies have been carefully monitoring sales of these decongestants because they are used to make Methamphetimine (“meth”), so you may need to ask the pharmacist for the product.