Don't let decongestants squeeze your heart

A stuffy nose is a hallmark of the common cold and allergic rhinitis. Chalk this symptom up to the body's immune response.

When you have a cold, virus-infected cells in the nose, sinuses, and throat attract a flood of white blood cells. These infection-fighters churn out substances that not only kill the cold virus but also swell nasal membranes and make the body produce extra mucus.

In people with hay fever or nasal allergies, the body's immune cells trigger the same type of response in the nose, sinuses, and throat.

For nasal congestion due to colds and allergies, millions of Americans reach for an over-the-counter decongestant. Some read the warning label, which states to ask a doctor before using if you have heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland. Few heed this warning.

But it's important to pay attention to this advice.

Oral decongestants

Pseudoephedrine and phenylephrine are oral decongestants; they are available alone (as in Sudafed and Sudafed PE) or as one of several ingredients in many cold and flu medications. Products containing pseudoephedrine must be purchased "behind the counter." You don't need a prescription, but you must ask a pharmacist or clerk for them, show an ID, and sign a log.

Because of these restrictions, the most common oral decongestant has become phenylephrine - but research has shown that it offers minimal symptom improvement. In 2024, the US Food and Drug Administration (FDA) proposed phasing out phenylephrine as an oral decongestant; if this occurs, products containing phenylephrine and promoted as decongestants will be removed from the market.

Decongestant effects beyond the nose

Pseudoephedrine and phenylephrine constrict blood vessels in the nose and sinuses. This shrinks the swelling and drains fluids, letting you breathe easier again.

Unfortunately, the drugs don't affect only the head - they tighten blood vessels throughout the body. So, one side effect is a possible increase in blood pressure. In general, this increase is minimal in people with normal blood pressure or controlled high blood pressure. But prior studies found a small percentage of people taking pseudoephedrine had marked increases in blood pressure.

Research has generally not shown the same concern for phenylephrine, though studies are few.

If you have high blood pressure and need to take one of these drugs, it's a good idea to have your blood pressure checked more often.

The FDA says that pseudoephedrine and phenylephrine are safe when taken as directed. Indeed, millions of people use these medications each year without any dire consequences. That doesn't mean they are risk-free. Over the years, pseudoephedrine use has been linked with reports of heart attacks, strokes, disturbed heart rhythms, and other cardiovascular problems, particularly when the medication is overused.

Alternatives to oral decongestants

Alternatives to oral decongestants are available. Antihistamines help treat allergy-related symptoms and also may help with cold symptoms. They are generally considered safe for the heart. But if you have heart disease or any other chronic condition or are taking other mediations, it's always safer to ask your primary care provider or pharmacist for a recommendation.

Newer antihistamines - such as cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Claritin) - have longer-lasting effects and are less likely to cause drowsiness, compared with older drugs like diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton). Research suggests that antihistamines are most effective during the first couple of days of use; after that, their effectiveness decreases.

Nasal sprays deliver a decongestant right where you need it. In theory, this should minimize cardiovascular effects. However, using nasal decongestant sprays for more than three consecutive days can lead to "rebound" nasal congestion, which can be worse than the original congestion. Excessive use also can be dangerous, so always follow the dosage instructions.

If you want to avoid medications altogether, you can try a variety of natural decongestants to clear your head. Breathe Right nasal strips may help you breathe better at night. A steamy shower or a hot towel wrapped around your face can relieve congestion. Nasal saline rinses, using a squeeze bottle, bulb syringe, or neti pot, can thin out mucus.

Also, drinking plenty of fluids, especially hot beverages, keeps mucus moist and flowing. Some people swear by spicy foods, and we would be remiss if we did not mention warm chicken soup, which may also ease congestion.

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