Download the Supporting patients in making a clear choice on a nasal decongestant poster here.

Nasal congestion can occur due to infection (such as the common cold, the flu or sinusitis), allergies (such as hayfever), nasal polyps or persistent rhinitis.² Less common causes include rebound congestion due to decongestant overuse, medication side effects or foreign bodies in the nose.²

Nasal congestion may occur alone or with other symptoms.  Cold and flu and allergic rhinitis also present with symptoms of nasal congestion.^4-6

Decongestants can provide short-term relief for nasal congestion and are available in many different forms. They can be sold individually or as an ‘all-in-one’ product combined with painkillers or antihistamines.⁷ Decongestants are available as nasal sprays, nasal drops, tablets, capsules and liquids (syrup).²

Nasal drops and sprays are effective for immediate and quick relief of symptoms. They should only be used for a maximum of 5-7 days due to the risk of rebound congestion.²

Oral decongestants do not work as quickly but may be suitable for use over a longer period of time if necessary.⁸

Decongestants relieve symptoms of nasal obstruction by causing constriction of the blood vessels in the nose. This reduces the swelling and thickness of the nasal mucosa.⁸

There are a number of decongestants available over-the-counter including:

Pseudoephedrine and phenylephrine are not suitable for use in patients with high blood pressure, heart disease, glaucoma , diabetes, hyperthyroidism, men with an enlarged prostate and people with liver, kidney, heart or circulation problems. When recommending these products it is important to check for interactions with other medicines.¹⁰

A patient-centred approach empowers patients to choose the correct treatment for their symptoms with advice from a healthcare professional. Before recommending any treatments you should ask the following:

 

Patients should be referred to their GP if symptoms have not improved after one or two weeks despite OTC treatments (treatment duration should not exceed seven days). Other symptoms that would require referral include:²

Refer to product details available on EMC for up to date product information.

Otrivine Extra Dual Relief 0.5 mg/ml + 0.6 mg/ml nasal spray, solution. (0.5 mg/ml xylometazoline hydrochloride and 0.6 mg/ml ipratropium bromide). Indications: Symptomatic treatment of nasal congestion and rhinorrhea in connection with common colds. Dosage: 1 puff in each nostril, up to 3 times daily, with at least 6 hours between doses. Not for use longer than 7 days. Contraindications: Children and adolescents under 18 years. Known hypersensitivity to xylometazoline hydrochloride or ipratropium bromide or any excipients or hypersensitivity to atropine or similar substances. Patients with glaucoma or rhinitis sicca or following transsphenoidal hypophysectomy or surgery exposing the dura mater. Warnings and precautions: Use with caution in people with: hypertension, cardiovascular disease, hyperthyroidism, diabetes mellitus, prostatic hypertrophy, bladder stenosis, pheochromocytoma, angle closure glaucoma, epistaxis, paralytic ileus, cystic fibrosis. Caution in people sensitive to adrenergic substances, which may cause sleep disturbances, dizziness, tremor, cardiac arrythmias or elevated blood pressure. Hypersensitivity reactions may occur. Do not use for more than 7 days. Use during pregnancy or breastfeeding only if clearly necessary. Avoid contact with eyes. Side effects: See SPC for full details. Hypersensitivity reactions (including angioedema, urticaria and bronchospasm). Localised irritation in the nose and throat, nausea, headache and dryness of the nasal mucosa. Systemic cardiovascular effects should be kept in mind in those with cardiovascular disease. In isolated cases, systemic allergic reactions, insomnia, fatigue, urine retention and transient visual disturbances. Price: £6.66 (ex. VAT) Legal Status: P. Licence Number: PL 44673/0153. Licence Holder: GlaxoSmithKline Consumer Healthcare (UK) Trading Limited, Brentford, TW8 9GS, UK.