Don’t let decongestants squeeze your
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
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 putting 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 constricts 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.
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 recommends 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
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