Decongestants: 6 Risky Conditions When Not To Use




That uncomfortable, stuffy I-can’t-breathe feeling is common during the cold season. Allergies, either seasonal or year-round, can also make you feel congested.

Fortunately, decongestants can help. As with all medicines, though, it’s important to use caution.

The causes of a stuffy nose vary depending on whether you have a cold or an allergy. In the cold, viruses invade the cells in your nose, sinuses, and throat.

In response, the body sends in the defense forces: white blood cells. The white blood cells assault and kill the viruses, but while they do, the substances they secrete to kill the viruses make your tissues swell. They also cause the body to make lots of mucus.

In allergies, a trigger sets off a reaction. A trigger can be seasonal, such as tree or grass pollen in the spring, or year-round, such as dust or animal dander in the house.

The body reacts to the trigger by producing histamines that lead to a runny or stuffy nose, watery eyes, and sneezing.

The stuffy nose may come later than the other symptoms.

A decongestant medication works by shrinking the swollen tissues in your nose and sinuses, clearing the air passages, and making breathing easier.

However, decongestants cannot help with sneezing or itchy, watery eyes caused by histamines; those must be dealt with by using an antihistamine.

Some cold or allergy products contain both a decongestant and an antihistamine.


Many decongestants people can purchase over the counter. They include nasal sprays, tablets, capsules, and syrups.

They vary in their active ingredients, which may be oxymetazoline, phenylephrine, or pseudoephedrine.

Pseudoephedrine-containing products do not require a prescription but are kept behind the counter in pharmacies. You may have to present identification to buy them, or you may be allowed to buy a limited number of them.

Nasal sprays work almost instantly because they are applied to the tissues of the sinuses and nose directly; tablets, capsules, and liquids take a bit longer to act because they have to be broken down and enter the bloodstream being swallowed.

Although sprays work more quickly, they have a downside. If used for more than three to five days, they can actually begin making congestion worse, a phenomenon called rebound congestion.

These medications often include other ingredients, such as acetaminophen or ibuprofen, which decrease pain and reduce fever.

If you are at present are taking one of these non-steroidal anti-inflammatory drugs, taking a decongestant that contains it as well can lead to complications.

Liquid decongestants may contain alcohol. Read the label, so you know exactly what you are taking. If you are not sure, you should contact your pharmacist or your doctor.


Decongestants shouldn’t be given to children less than 6 years old unless advised otherwise by their doctor.

Children between 6 and 12 can take decongestants that are not accompanied by other medications within a multi-symptom cold or flu remedy. Still, the adult must be careful to follow package instructions regarding dosage.

Adults need to be careful when taking decongestants as well. For some people, decongestants make them feel on-edge.

If that happens to you, try to cut caffeine down or out of your diet while taking the decongestant.

Some people should avoid decongestants that contain pseudoephedrine because of the way that medication acts.

To shrink the tissues and relieve congestion, pseudoephedrine shrinks blood vessels not just in the nasal passages but throughout the body, causing blood pressure to increase.

Avoid decongestants with pseudoephedrine if you have:

  • diabetes
  • uncontrolled high blood pressure
  • glaucoma (elevated pressure inside the eye)
  • heart problems
  • problems with your thyroid gland, or
  • an enlarged prostate


If you have one of those conditions and struggle with congestion, you might want to try some more old-fashioned remedies.

A hot, steamy shower can relieve nasal congestion, as can a warm, damp towel over the face.

Room humidifiers, which change water into steam, can help, especially when the person with the congestion is an infant or child.

Drinking lots of liquids, including water, tea, and soup, can help thin out the mucus and make breathing easier.

Also, some people find Neti pots effective. Coming from the Ayurvedic tradition of medicine, the Neti pot looks like a small teapot.

The teapot’s spout goes into one nostril as the user leans over a sink, and a solution of purified water and salt is poured into the sinus passages.

The solution flushes mucus and irritants out of the nose and sinuses, and studies have found it an effective alternative to medications.

There are two important caveats: make sure the water is sterile before you use it because tap water can contain organisms that can cause problems if introduced into the sinuses, and be ready for a mild feeling of drowning the first time you use the treatment.

Many Neti pots come with ready-to-use packets that can be used to make the saline solution.

The same saline irrigation accomplished by the Neti pot can be done with a specially designed soft plastic squeeze bottle.

Another form of saline irrigation that is less complicated than using a Neti pot is to use an over-the-counter saline nasal spray.

These sprays are less messy than using a Neti pot and have an advantage over decongestant sprays in that they can be used frequently without any ill effects.

They are safe for people of all ages and cost less than decongestant sprays.



“Don’t let decongestants squeeze your heart.” Harvard Health Letter. April 3, 2019. (accessed March 1, 2021).

Fookes, C. “Decongestants.” August 3, 2018. (accessed March 1, 2021).

Harding, Mary. “Decongestants.” Patient. February 20, 2018. (accessed March 1, 2021).

Kiefer, Dale. “Decongestants to Treat Allergy Symptoms.” Healthline. August 20, 2018. (accessed March 1, 2021).


American Academy of Allergy, Asthma, and Immunology, 555 East Wells Street, Suite 1100, Milwaukee, WI, 53202-3823, (414) 272-6071,

American Academy of Otolaryngology, 1650 Diagonal Rd., Alexandria, VA, 20824, (703) 836-4444,