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Understanding Allergy and Hay Fever Medications (cont.)

Decongestants

Pseudoephedrine (Sudafed), naphazoline (4-Way Fast-Acting Nasal Spray), and oxymetazoline (Afrin Nasal Spray) are examples of decongestants. Due to increasing abuse of pseudoephedrine (as a stimulant in athletics and in the illegal production of methamphetamines), phenylephrine has been substituted for pseudoephedrine in many over-the-counter preparations. Phenylephrine is less effective than pseudoephedrine for the treatment of rhinitis symptoms. Many over-the-counter products are available for purchase at the pharmacy counter that contain pseudoephedrine (rather than being freely available on store shelves).

  • How decongestants work: These drugs decrease nasal congestion by causing blood vessel constriction (narrowing) and reduced blood flow to the nasal passage.
  • Who should not use these medications: These medications should not be used in those who are allergic to them. They may cause unwanted side effects in individuals with the following conditions:
    • Narrow-angle glaucoma
    • Poorly controlled high blood pressure
    • Coronary artery disease (hardening of the arteries)
  • Use: Decongestants are available over the counter in oral (tablets, capsules, liquids) and nasal-spray forms. Many combination preparations are available that combine decongestants with first- or second-generation antihistamines. The individual preparations vary in regard to how often the drug should be taken each day. Use of nasal sprays as directed should be for temporary relief only (no longer than three to five days). Prolonged use can cause worsening congestion.
  • Drug or food interactions:
    • Avoid within two weeks of taking MAOIs (for example, isocarboxazid [Marplan], pargyline [Eutonyl], procarbazine [Matulane], and tranylcypromine [Parnate]).
    • Use caution with herbal drug preparations that also increase blood pressure, such as ephedra (Ma Huang).
    • Illicit drugs (such as cocaine) may also cause increased blood pressure.
  • Side effects: Do not use decongestant nasal sprays for more than three to five days. Use beyond three to five days causes swelling in the nasal passages and aggravates allergic symptoms. Oral decongestants may increase blood pressure, cause or aggravate existing heart rhythm abnormalities, and/or cause wakefulness and difficulty falling asleep.
Medically Reviewed by a Doctor on 8/6/2014

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