The Family Health Guide

Don’t let decongestants squeeze your heart

Don't let decongestants squeeze your heart

During cold season, millions of Americans reach for an over-the-counter decongestant to clear a stuffy nose. Some read the warning label: "Do not use this product if you have heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland unless directed by a doctor." Few heed it.

Many of your favorite decongestants are no longer so easily available on pharmacy shelves. Others are getting an ingredient makeover. These changes are part of a national effort to close down home-based methamphetamine labs. Methamphetamine is a highly addictive street drug that is easily made from pseudoephedrine, the active ingredient in Sudafed and hundreds of other over-the-counter (OTC) decongestants.

Some states have passed laws put-ting products containing pseudoephedrine behind the counter. You don't need a prescription, but you do have to ask a pharmacist or clerk for them and show an ID or sign a log. Bills working their way through the U.S. Congress as of late 2005 could make this a national change.

Fearing that customers will shy away from asking for these products, some drug companies are replacing pseudoephedrine with a similar over-the-counter decongestant called phenylephrine that can't be made into methamphetamine.

Is phenylephrine just like pseudoephedrine for people with heart disease? Unfortunately, no one is certain. There are very few studies to date.

Effects beyond the nose

Pseudoephedrine con-stricts blood vessels in the nose and sinuses. This shrinks swelling and drains fluids, letting you breathe easier again. Unfortunately, the drug doesn't affect only the head — it tightens blood vessels throughout the body. One effect is a possible increase in blood pressure. In research trials most people showed a minimal increase in blood pressure. Only 3% had a marked increase in blood pressure.

The FDA says that pseudoephedrine is safe when taken as directed. That doesn't mean it's risk free. Over the years, there have been reports of heart attacks, strokes, disturbed heart rhythms, and other cardiovascular problems linked with use of pseudoephedrine.

Phenylephrine has been in nasal sprays such as Neo-Synephrine and Vicks Sinex for years. It never made it big as an oral drug, though. Since it is in the same class of drugs as pseudoephedrine, it carries the same FDA safety rating. Phenylephrine is expected to have similar effects on congestion and the cardiovascular system as pseudoephedrine, but that remains to be seen.

Simple switches

Most people can take an over-the-counter decongestant without a hitch. If you have high blood pressure or heart disease, the American Heart Association recom-mends playing it safe. That means talking with your doctor first, or trying a remedy that doesn't contain a decongestant.

Alternatives are available. In the drug realm, antihistamines such as Benadryl, Chlor-Trimeton, Zyrtec, and Claritin can help with a stuffy nose from a cold and are safe for the heart. The American Heart Association Web site touts the Coricidin HBP line of over-the-counter drugs for people with high blood pressure. Nasal sprays deliver a decongestant and should minimize cardiovascular effects.

If you want to avoid medications altogether, you can try a variety of things to clear your head. Breathe Right nasal strips, and a steamy shower, can relieve congestion. Drinking plenty of hot fluids, keeps mucus moist and flowing.

January 2006 Update