Nasal congestion is a common ailment that is not always easy to resolve. You may think that you have only one or two options when it comes to medicating this condition, but there are actually many types of nasal decongestant. Here is a quick comparison:
| Type | Advantages | Disadvantages |
|---|---|---|
| Oral formulations (pills) | Decongestant effect evenly applied; reaches all nasal tissue | Take hours or days to work |
| Intranasal sprays (liquid) | Take minutes to work | Does not reach all nasal tissue - only tissue it touches |
| Intranasal inhalers (gas) |
Here is a detailed comparison:
| Drug name | Legal status | Brand name(s) | Effects | Rebound congestion? | Review | Technical details |
|---|---|---|---|---|---|---|
| Oral formulations (pills) | ||||||
| pseudoephedrine | OTC (restricted*) | Sudafed®, Wal-Phed® | Noticeable after ~1 hour, full effect after ~2 hours. Lasts ~2-3 hours. | None noticeable. | Pseudoephedrine remains the gold standard oral medication for nasal decongestion. Its side effects are milder than other sympathomimetics, such as ephedrine. | substituted amphetamine (sympathomimetic); *In U.S., requires purchase from pharmacy counter and presentation of state I.D. |
| phenylephrine | OTC | ??? | ??? | I experienced nausea and no decongestant effect from this drug. Results may vary so this may be worth trying, anyhow. | ||
| ephedrine | OTC (restricted*) | Bronkaid®, Primatine® | ??? | ??? | Because ephedrine has a stronger bronchodilator effect than nasal decongestant effect, this drug is not recommended (or marketed for) nasal decongestion. | substituted amphetamine (sympathomimetic) *In U.S., requires purchase from pharmacy counter and presentation of state I.D. |
| montelukast | ℞ only | Singulair® | Noticeable in ~3-7 days, full effect in ~14 days. Lasts ~3 days. | Not noticeable. | Montelukast causes a mild increase in air flow that is present all day long. It is effective only for those experiencing leukotriene-instigated airway inflammation, due to conditions such as allergic rhinitis or allergic asthma. | antileukotriene; ℞ due to suicidal ideation in small fraction of patients; FDA declined to make OTC in 2014. |
| Intranasal sprays (liquid) | ||||||
| phenylephrine | OTC | Wal-Four® | Fastest decongestant. Noticeable in 1-4 minutes, full effect after ~20 minutes. Lasts 3-4 hours. | ??? | In its nasal spray form, phenylephrine seems less likely to cause burning than oxymetazoline. It is also slightly faster-acting than oxymetazoline, but lasts only 1/3 as long (4 hours instead of 12 hours). If used before sleeping, you may wake up to find you need to re-use. | |
| oxymetazoline | OTC | Afrin® | Noticeable in ~5 minutes, full effect after ~20 minutes. Lasts 12 hours total. | Next day causes runny nose and mild rebound | The fastest-acting, longest-acting nasal decongestant. | Effectiveness can lead to user dependence (rhinitis medicamentosa) |
| Intranasal inhalers (gas) | ||||||
| L‑methamphetamine | OTC | Sinu Inhaler™ | Noticeable after ~10 minutes, full effect after ~30 minutes. Lasts ~2 hours total. | Not noticeable. | Instead of acting directly to cause vasoconstriction, levomethamphetamine causes a temporary increase in the release of catecholamines, thereby indirectly causing mild decongestion. For some reason, sometimes it is moderately effective, and other times completely ineffective. More expensive than intranasal sprays, so that combined with irregular efficacy may explain why this is not a popular decongestant. | Also labeled as: levomethamphetamine or levmetamfetamine; L-enantiomer form of methamphetamine -- legal in U.S. |
| propylhexedrine | OTC | Benzedrex® | 2 hours | Not noticeable | Harsher than levmatamfetamine nasal inhaler, but slightly more effective. |
Of course, it would be a good idea to consult with a physician — some of the above medicines are contraindicated in the young or elderly. Good luck!