Decongestants are medications used to relieve nasal congestion and sinus pressure by reducing swelling of the nasal passages. They are commonly available over-the-counter and in prescription forms.
Generic names: Pseudoephedrine, Phenylephrine
Brand names: Sudafed, Afrin, Neo-Synephrine, Suphedrine, Sudafed PE, Dimetapp, Vicks Sinex, Mucinex D
Pharmacologic class: Sympathomimetic amines
Therapeutic class: Nasal decongestant, vasoconstrictor
Mechanism of action: Decongestants work by stimulating alpha-adrenergic receptors, causing vasoconstriction of blood vessels in the nasal passages. This reduces blood flow and swelling in the nasal mucosa, leading to decreased congestion and improved airflow.
Indications for use: Nasal congestion, sinus pressure, upper respiratory tract infections, allergic rhinitis, sinusitis, otitis media, and eustachian tube dysfunction.
Precautions and contraindications:
- Hypertension
- Coronary artery disease
- Diabetes mellitus
- Hyperthyroidism
- Glaucoma
- Prostatic hypertrophy
- Pregnancy (especially first trimester)
- Children under 4 years old
- MAO inhibitor use within 14 days
Drug Interactions:
- MAO inhibitors (risk of hypertensive crisis)
- Beta-blockers (reduced effectiveness)
- Other sympathomimetic drugs
- Antihypertensive medications
- Digitalis glycosides
- Tricyclic antidepressants
Adverse Effects:
- Increased blood pressure
- Tachycardia
- Anxiety and nervousness
- Insomnia
- Tremors
- Dry mouth
- Urinary retention
- Headache
- Dizziness
- Rebound congestion (with prolonged nasal spray use)
Administration Considerations:
Available preparations:
- Oral tablets (immediate and extended-release)
- Nasal sprays
- Liquid formulations
- Combination products with antihistamines or pain relievers
Dosages:
- Pseudoephedrine: Adults and children 12 years and older: 60mg every 4-6 hours or 120mg extended-release every 12 hours
- Phenylephrine: Adults and children 12 years and older: 10-20mg every 4 hours
- Nasal sprays: 2-3 sprays per nostril every 4-6 hours for no more than 3 days
Nursing Considerations for Decongestants
Related Nursing Diagnoses:
- Ineffective breathing pattern
- Impaired nasal breathing
- Risk for adverse effects
- Knowledge deficit regarding medication use
- Risk for injury related to stimulant effects
Nursing Assessment:
- Assess vital signs, especially blood pressure and heart rate
- Evaluate nasal congestion severity and duration
- Review medical history for contraindications
- Check for drug interactions with current medications
- Assess renal and cardiovascular function
- Monitor for signs of rebound congestion with nasal sprays
Nursing Interventions:
- Monitor vital signs regularly, especially in patients with cardiovascular conditions
- Assess the effectiveness of decongestant therapy
- Observe for signs of adverse effects
- Implement blood pressure monitoring protocol if indicated
- Document response to therapy and any side effects
- Provide patient education about proper use and potential side effects
Patient Teaching Associated with Decongestants:
- Take oral decongestants with plenty of water
- Do not exceed the recommended dosage or duration of use
- Stop use and contact a healthcare provider if experiencing:
- Severe headache
- Rapid heartbeat
- Increased blood pressure
- Difficulty urinating
- For nasal sprays:
- Proper technique for administration
- Limited duration of use (3 days maximum)
- Risk of rebound congestion with prolonged use
- Lifestyle modifications:
- Adequate hydration
- Use of humidifiers
- Nasal saline irrigation
- Head elevation during sleep
- Avoid alcohol consumption while taking decongestants
- Do not drive or operate machinery if experiencing drowsiness
- Store medications at room temperature away from moisture
Additional Considerations:
- Monitor blood glucose in diabetic patients
- Use with caution in elderly patients
- Avoid evening doses to prevent insomnia
- Consider alternative treatments for chronic congestion
This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult with a pharmacist for complete information.
References:
- Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016 Oct 17;10(10):CD009612. doi: 10.1002/14651858.CD009612.pub2. PMID: 27748955; PMCID: PMC6461189.
- Hom J. Do decongestants, antihistamines, and nasal irrigation relieve the symptoms of sinusitis in children? Ann Emerg Med. 2013 Jan;61(1):35-6. doi: 10.1016/j.annemergmed.2012.03.016. Epub 2012 Apr 19. PMID: 22520993.
- Mehuys, E., Gevaert, P., Brusselle, G., Van Hees, T., Adriaens, E., Christiaens, T., Van Bortel, L., Van Tongelen, I., Remon, J., & Boussery, K. (2014). Self-Medication in Persistent Rhinitis: Overuse of Decongestants in Half of the Patients. The Journal of Allergy and Clinical Immunology: In Practice, 2(3), 313-319. https://doi.org/10.1016/j.jaip.2014.01.009
- Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
