Nasal Allergy Medications

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

What are side effects of decongestants?

Topical sprays sometimes cause burning or dryness in the nose. The most notorious side effect of topical decongestants is rebound nasal congestion. The longer someone uses the spray, the less effective it becomes and the more they need to use it in order to obtain the desired effect (virtually an addictive quality if used excessively). After prolonged use, the spray begins to cause more congestion than it relieves. The only way to break this cycle is to stop the medication. If the cycle is not broken, permanent changes can occur on the nasal membranes, which lead to a condition known as rhinitis medicamentosa. Rhinitis medicamentosa refers to an inflammation in the nose that is caused by the use of medications. Symptoms include severe stuffiness, burning, bleeding, and dryness of the nose.

Side effects from oral decongestants are more common and potentially more dangerous. They can stimulate the nervous system causing palpitations, insomnia, nervousness, and irritability. Some people may have trouble with urination and a decreased appetite. Although frequently mentioned, high blood pressure is not commonly caused or worsened by these drugs. However, any concerns regarding the side effects of these drugs should be discussed with the doctor.

What about combination antihistamine/decongestant preparations?

Pharmacy shelves are packed with combination preparations. They are useful for runny, itchy, and stuffy noses and are available OTC or by prescription. The liquid preparations are convenient for children as well as the elderly who may need a lesser dosage than is available in tablet forms. 12- and 24-hour preparations are available to make taking the medications more practical. Interestingly, the stimulant effect of the decongestant may counteract the drowsiness effect of the antihistamine and make the combination well tolerated; however, this may not occur in everyone so caution is indicated.

Common Antihistamine/Decongestant Preparations
Generation Brand Name R = Rapid Release; S= Sustained Release Antihistamine Decongestant
First Drixoral R dexbrompheniramine pseudoephedrine
ChlorTrimenton S chlorpheniramine pseudoephedrine
Second Allegra D S fexofenadine pseudoephedrine
Claritin D 12-hour S loratadine pseudoephedrine
Claritin D 24-hour S loratadine pseudoephedrine
Semprex D S acrivastine pseudoephedrine

Two broad categories of decongestants are available. Rapid release products need to be taken 3 to 4 times a day and provide a lower dose of both the antihistamine and decongestant. These medicines help people who are more troubled by side effects but they are less practical than the sustained release preparations, which need to be taken only once or twice per day.

Some combinations of these drugs may be more effective in some individuals, If an individual wants to try a new OTC antihistamine/decongestant combination, they should carefully read the label. Make sure the ingredients and the dosages are different from the ones they used to take. Otherwise, the person may be buying the same medication they took previously, only with a different name, color, shape, and price.

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