Choosing a Decongestant for Allergy Symptoms

Yesterday, my sister-in-law Ann called me for advice. She’s suffering from allergies.

“My nose is so stuffed up, I have to breathe through my mouth. I’ve been taking a decongestant, but it isn't working. Can you develop an immunity to Sudafed®?”

 “When you got the last box of Sudafed®, did you pick it up off the cough and cold shelf, or did you have to sign something before buying it?”

“I got it from the cough and cold section of the grocery store.”

“The Sudafed® found on the shelves of the cough and cold medicine sections of pharmacies and grocery stores today is not the Sudafed® that you remember. The name on the box is a little different, too. It’s now Sudafed PE® instead of Sudafed®.

Ann, you’re not getting the relief you used to get because you’re not taking the same medicine. Your older version of Sudafed® contained pseudoephedrine. The formula you bought off the shelf, called Sudafed PE®, contains phenylephrine. While it’s true that pseudoephedrine and phenylephrine are both decongestants designed to relieve stuffy nose symptoms, the newer version isn’t as effective.”

There are two reasons for this. One reason is that the over-the-counter version of Sudafed PE® is less effective than its original formula. Another reason is not everyone absorbs the entire dose of Sudafed PE®. Some of it gets left behind in their gut instead of going into their bloodstream to help their nasal congestion symptoms.

Phenylephrine and pseudoephedrine are equally effective as nasal decongestants when taken as a 30mg tablet. Unfortunately, phenylephrine can cause high blood pressure and strokes when taken at that dose. For public safety, the Food and Drug Administration (FDA) limited the amount of phenylephrine to 10mg, just one-third of its effective dose. Sudafed PE® is unlikely to cause serious side effects but is also unlikely to give as much relief from a stuffy nose as its older cousin, pseudoephedrine.

Phenylephrine is sold as Sudafed PE® tablets, syrup, and Neo-Synephrine® nose spray and drops.

Why was an effective non-prescription decongestant medicine replaced with a “wimpy” one? Because pseudoephedrine is a critical ingredient in making methamphetamine. In 2005, the USA Patriot Act restricted the sale of crucial components, called precursors, used to manufacture methamphetamine, to combat meth production, trafficking, and abuse.

The compounds identified as methamphetamine precursors were ephedrine, phenylpropanolamine, and pseudoephedrine (the generic name of Sudafed®). Beginning on September 30, 2006, products containing any of these were kept “behind the counter” in pharmacies or under lock and key by grocery stores and other vendors.

To fully address Ann’s allergy symptoms, she needs more than just a switch to the older version of Sudafed®. In addition to a decongestant, Ann should also include an antihistamine. When you’re suffering from both a runny nose and a stuffy nose, some antihistamines are better at relieving those symptoms than others.

Newer antihistamines like Claritin® and Allegra® cause less drowsiness but don’t help dry up a runny nose (rhinorrhea) as effectively as older drugs. Zyrtec®-D (cetirizine plus pseudoephedrine) and Actifed® (triprolidine plus pseudoephedrine) are my favorites to address both a runny and stuffy nose from a common cold or allergies. These combination medications don’t usually cause drowsiness and work well to dry up a runny nose.

Actifed® can be hard to find, as many younger pharmacists have never heard of it. You’ll need to ask for it behind the counter. It’s generic version, Aprodine® from Major® Pharmaceuticals, has been unavailable for most of this year. Luckily, when I asked my pharmacy if they could order it this week, it’s available again, just in time for ragweed season!

Here Are 5 Tips for Using a Decongestant Effectively:

1.     Don’t use a decongestant to treat a runny nose.

A decongestant can relieve a stuffy nose but often worsens a runny nose. Use an antihistamine instead for allergy symptoms.

2.     Avoid phenylephrine tablets and nose spray.

More effective decongestant choices, such as the older form of Sudafed® (pseudoephedrine) as tablets and Afrin® (naphazoline) as a nasal spray, are available.

3.     Avoid oral decongestants if you have high blood pressure.

Use just an antihistamine alone, or a decongestant nasal spray like Afrin® (naphazoline).

4.     Limit the use of decongestant nose sprays.

Avoid using any decongestant nasal spray for more than 3 days in a row to avoid triggering “rebound”, a worsening of your stuffy nose symptoms.

5.     Use an antihistamine PLUS a decongestant to relieve both a stuffy and runny nose.

Adding an antihistamine will relieve overall allergy symptoms and dry up a runny nose. 

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com.

Ó2023 Louise Achey