Allergy Treatments

Your Guide to Taking Decongestants for Your Allergies

Picnic's over-the-counter nasal spray and a bottle of antihistamines on a tray sprinkled with pollen.

None of your allergy symptoms are fun to deal with. But, let’s talk about one of the most common and annoying ones: nasal congestion.

You feel like you have concrete in your nostrils. You can’t smell anything. Your lips are chapped from constantly breathing through your mouth. You’re miserable.

The good news is that there’s something that can help you clear up your congestion and breathe a little easier (literally): decongestants.

But what exactly is a decongestant? And how do you know which one to pick? We’ve got answers to your questions right here.

What is a nasal decongestant?

A nasal decongestant is a medication that opens up your stuffy nose. Decongestants come in a variety of forms, including:

Most decongestants are available over the counter. However, those that have pseudoephedrine as the active ingredient are sold behind the counter. In most cases, you can still get them without a prescription—you’ll just need to ask the pharmacist to get it for you.

How do decongestants work to, well, decongest?

We’ll spare you the major anatomy lesson, but here’s the gist of what’s happening in your body: Your immune system attempts to fight your allergic rhinitis, virus, common cold, or infection by sending extra blood to your nose. That causes your nasal tissues and blood vessels to swell up, which leads to congestion.

Decongestants narrow your blood vessels and reduce swelling in your tissues so you can breathe through your nose again.

How long does it take a decongestant to work?

Now that you understand the magic behind these medications, here’s the information you really want: How long do you need to wait before you start to feel some relief?

That depends on the specific type of decongestant you’re taking (which we’ll get into in the next section).

Pseudoephedrine, a pill, will usually start working within 15 to 30 minutes, and you can expect to breathe a lot easier within an hour. A decongestant nasal spray like Afrin usually starts working immediately after you use it.

The effects of most decongestants will last anywhere from three to 12 hours. So, while it’s not a permanent fix for your clogged up nose, it can provide some temporary relief.

What types of decongestants exist?

Decongestants all work to reduce swelling in your nose. But, as we mentioned earlier, there are a number of different ones to choose from. They all contain one of the following active ingredients:

  • Pseudoephedrine
  • Phenylephrine
  • Oxymetazoline

Pseudoephedrine is the most common, as the efficacy of phenylephrine has been disputed by researchers. Oxymetazoline is a topical decongestant, and is generally only available in nasal sprays and drops. Here are some of the most common decongestants in each category:

  • Pills: Sudafed®, Sudafed PE®, Mucinex Sinus-Max®
  • Liquids: Same brands as the pills, but liquid
  • Nasal sprays and drops: Afrin®, Vicks® Sinex

There are also a number of other medications that combine a decongestant with something else—such as an antihistamine, expectorant (an ingredient that loosens mucus), or a pain reliever.

How do I know which one is right for me?

Needless to say, you have plenty of options. But, how can you figure out which decongestant is right for you? There’s more to it than closing your eyes and picking one. Let’s talk about a few things you should consider.

1. Do you want faster relief or longer relief?

A decongestant nasal spray will provide immediate and more intense relief. But, it can also be shorter-lived than oral decongestants. Pills or liquids take a little more time to work, but many can last for up to 12 hours.

That’s something worth considering when figuring out which decongestant to reach for. For example, if you need to clear up a stuffy nose fast ahead of a work presentation, then you might want to opt for a nasal spray. But, if you’d rather get some extended relief, then a pill or liquid is probably your best bet.

2. Do you have high blood pressure?

Decongestants work by narrowing your blood vessels. That’s good news for your stuffiness, but not such great news if you already have high blood pressure.

For that reason, the Mayo Clinic suggests that people who have high blood pressure skip decongestants and instead opt for pain relievers or saline nasal sprays.

3. Which method are you comfortable with?

Finally, personal preference should factor into your decision. Some people are nervous about spraying something up their nostrils and would prefer an oral medication. Others love the idea of delivering treatment directly to the problem area and grab a nasal spray every time.

Don’t neglect to think about what you feel comfortable with. That’s important too!

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Is there any downside to using a decongestant?

Once you’ve made your choice, you’re probably wondering if there’s anything else you should be aware of. Decongestants are typically safe, but much like any other type of medication, they come with some risks and side effects.

It’s always smart to read the directions and packaging of whatever decongestant you select. But, speaking generally, some of the most common side effects include:

  • dizziness or light-headedness
  • fast or pounding heartbeat
  • headache
  • nervousness or restlessness
  • trouble sleeping

Typically, if side effects do occur, they’re mild. If you have questions or concerns about anything you’re experiencing, connect with a medical professional.

In terms of risks, keep in mind that decongestants aren’t recommended for people with high blood pressure, as they can increase blood pressure or interfere with the effectiveness of blood pressure medications.

But, the biggest risks of decongestants relate to prolonged use—particularly of decongestant nasal sprays. Because they provide such intense relief, people can be tempted to overuse them. That extended use can cause something known as the “rebound effect,” where your nasal passages become less responsive to the medication and your congestion actually worsens.

For that reason, most nasal sprays shouldn’t be used for longer than three days. Again, check the packaging to make sure you’re using the medication as directed.

Will a decongestant solve all of your allergy problems?

Unfortunately, no. A decongestant can provide some relief from your obnoxious stuffy nose, but a decongestant alone won’t make your entire allergy season a piece of cake.

If you really want to get ahead of your allergy symptoms, an antihistamine is far more preventative and will help keep your stuffy nose at bay in the first place.

But if you still can’t move any air through your nostrils? A decongestant is a great way to clear up your nasal passages while you wait for your antihistamine to kick in. Breathe in, breathe out, and enjoy that relief.

ARTICLE REVIEWED BYAmina H. Abdeldaim, MD MPHPicnic Medical Director
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