Don't let decongestants squeeze your heart

As many over-the-counter decongestants get a new ingredient, you might want to look for alternatives.

During cough and 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.

But it might be good to pay attention to the warning. 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 "meth labs" that churn out methamphetamine, 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 a pharmacist or clerk 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? "This is a black hole of knowledge," says W. Stephen Pray, the Bernhardt Professor of Nonprescription Drugs and Devices at Southwestern Oklahoma State University. "There are very few studies, and we don't have that much experience with phenylephrine."

Effects beyond the nose

A stuffy nose is a hallmark of the common cold. Chalk this symptom up to the body's immune response. Virus-infected cells in the nose, sinuses, and throat attract a flood of white blood cells. These infection fighters churn out substances that kill the cold virus but also swell nasal membranes and make the body produce extra mucus.

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 general, this increase is minimal, even in people with controlled high blood pressure, according to a review of 24 trials of pseudoephedrine and blood pressure published in the August 8/22, 2005, Archives of Internal Medicine.

Not everyone is average. Among the people who took part in these studies, about 3% had marked increases in blood pressure.

The FDA says that pseudoephedrine is safe when taken as directed. Indeed, millions of people use it each year without any dire consequences. 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, especially with products containing phenylephrine. That means talking with your doctor first, or trying a remedy that doesn't contain a decongestant, says Dr. Fernando Costa, an AHA science and medical adviser.

Alternatives are available. In the drug realm, antihistamines such as diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), cetirizine (Zyrtec), and loratadine (Claritin) can help with a stuffy nose from a cold and are safe for the heart, says Dr. Raymond Woosley, an expert on the cardiac effects of antihistamines. The American Heart Association Web site touts the Coricidin HBP line of over-the-counter drugs for people with high blood pressure. These combine chlorpheniramine with other OTC agents.

Nasal sprays deliver a decongestant right where you need it. In theory, this should minimize cardiovascular effects; in practice it may not.

If you want to avoid medications altogether, you can try a variety of things to clear your head. Breathe Right nasal strips may help you breathe better at night. A steamy shower or a hot towel wrapped around the face can relieve congestion. Drinking plenty of fluids, especially hot beverages, keeps mucus moist and flowing. Some people swear by spicy foods, and we would be remiss for failing to mention chicken soup.