Decongestants for sinusitis


Generic Name Brand Name
oxymetazoline hydrochloride Afrin
phenylephrine hydrochloride Neo-Synephrine
pseudoephedrine hydrochloride Sudafed

These products are available as nasal sprays, nose drops, tablets, and liquids.

In some states, medicines containing pseudoephedrine (such as Sudafed) are kept behind the pharmacist's counter or require a prescription. You may need to ask the pharmacist for it or have a prescription from your doctor to buy the medicine.

How It Works

Decongestants reduce swelling of the mucous membrane in the nose and sinuses associated with sinusitis by constricting blood vessels and reducing the blood supply to nasal mucous membranes. This reduces nasal congestion, stuffiness, and runny noses.

Unlike oral decongestants, nasal decongestants constrict blood vessels only in the nose and not in other parts of the body; therefore, they rarely cause the side effects that oral decongestants do. Unfortunately, use of nasal decongestants is safe only for a short period of time, because their use can lead to further swelling of the sinus membranes as they wear off, creating more congestion, which in turn requires higher doses of medication (called rebound congestion).

Why It Is Used

Decongestants are used to treat symptoms caused by nasal blockage and sinusitis. They may be used along with antibiotics and home treatment.

How Well It Works

Decongestants do not cure sinusitis, but they may reduce symptoms.1

Nasal sprays cannot reach the mucous membranes deeper in the nose and inside the sinuses. Oral decongestants may be necessary to reduce swelling in these areas.

Side Effects

If a nasal decongestant spray is used more often, at higher doses, or for a longer time than is recommended, rebound congestion may occur.

Side effects of decongestants may include:

  • Reduced movement of mucus out of the nose (ciliostasis).
  • Decreased blood flow to the mucous membrane in the nose and sinuses, reducing the speed at which antibiotics get into the sinuses.
  • Increased blood pressure.
  • Dizziness.
  • Nervousness or irritability.
  • Trouble sleeping (insomnia).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Nasal sprays containing decongestants should not be used for more than 3 days in a row. If used for longer periods, you may have rebound congestion.

Avoid decongestant medications that contain antihistamines unless your doctor specifically recommends them.

Avoid taking too much of a decongestant because it can cause high blood pressure, nervousness, kidney failure, heart rhythm disturbances, strokes, and seizures. Commonly used decongestants have little effect on blood pressure when used as directed. Talk with your health professional first before using decongestants if you have uncontrolled high blood pressure.

Avoid taking two medications that contain decongestants at the same time because of possible overdose. Many nonprescription preparations for other health problems, such as some diet pills, contain decongestants.

Talk to your health professional before using decongestants if you have problems with blood flow to the heart (ischemic heart disease), diabetes, or thyroid problems. Also, talk with your ophthalmologist before using decongestant medications if you have glaucoma or other conditions that cause increased pressure inside the eye. Before prescribing a decongestant, your health professional will want to know whether you are taking tricyclic antidepressants or monoamine oxidase inhibitors (MAOIs), which are sometimes used to treat depression and migraine headaches.

Saline (saltwater) nasal sprays may also help clear up a stuffy nose. Also, you can treat a stuffy nose with saltwater nasal washes (saline lavage or irrigation). Both are available at pharmacies without a prescription.

Do not give decongestants to a child younger than 2 unless you've checked with the doctor first. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do. Using saline drops or a humidifier may help thick or dried mucus to drain. To remove mucus from your baby’s nose, use a suction bulb to gently suction the mucus out. These are safer ways to treat your baby's stuffy nose.

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  1. Shah AR, et al. (2008). Acute and chronic sinusitis. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, section 4, pp. 273–281. New York: McGraw-Hill.

Last Updated: August 15, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: Kathleen Romito, MD - Family Medicine & Donald R. Mintz, MD - Otolaryngology

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