Nasal congestion can be a real nuisance, causing difficulty breathing and even headaches. Everyone has experienced it at some point in their lives, whether it’s because of seasonal allergies, a cold, or even dust or pet allergens. Fortunately, there are many products available that can help you unblock your nose and get on with your day. In this article, we’ll cover the different types of over-the-counter oral medications and nasal sprays available to treat nasal congestion, the benefits and side effects of each one, and how to choose the best decongestant for you. Let’s dive deeper!
Oral Medications for Nasal Congestion
If you’re looking for an over-the-counter (OTC) oral decongestant for nasal congestion, two of the most popular options are pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE). However, these medications are not created equal. A 2009 study found phenylephrine, which is found in many pharmacy medicines, is no better than placebo; whereas pseudophedrine, which is kept behind the counter, is significantly better than placebo. 
Pseudoephedrine works by opening up the blood vessels in your sinuses so that they can drain properly―helping to reduce inflammation and providing relief from congestion symptoms. However it may have side effects such as headache, nervousness, and difficulty sleeping, so it is recommended for use during the day and to try something else if you have nasal congestion at night.
Other medications to consider would be oral antihistamines like cetirizine (Zyrtec) or loratadine (Claritin, Claratyne) if your congestion is due to allergies. It may not work as well for nasal congestion as a nasal spray will, but adding an antihistamine into the mix can potentially help, as well as ease other symptoms such as runny nose, itchy eyes and ears.
Nasal Sprays for Nasal Congestion
There are several types of OTC nasal sprays available that can help relieve nasal congestion quickly. The most common are oxymetazoline (Afrin, Sudafed), and Xylometazoline (Otrivin) which both work by constricting blood vessels in the nose to reduce inflammation and swelling. The former (oxymetazoline) is usually associated with less side effects. It’s important to note that using these too frequently – usually more than 3 days in a row – can cause rebound congestion—where the symptoms return after the spray wears off (up to 12-24 hours)—and dependency on the medication can form.
If this happens to you, see the below section on Breaking Rebound Congestion.
Breaking Rebound Congestion
If you find yourself stuck in a cycle of rebound congestion due to overly frequent use of nose sprays like Oxymetazoline or Xylometazoline, there is hope!
Probably the most effective way to break this cycle is to switch to an oral medication like pseudoephedrine, as the time required to become dependent on it is much longer. It is still recommended however, not to rely on it for longer than necessary.
There are also other nasal sprays available on the market that may help and don’t have the same habit forming side effects such as azelastine (Azep) cromolyn sodium (Nasalcrom) or nasal steroids such as fluticasone (Flonase, Flixonase), mometasone (Nasonex) and others.
Nasal antihistamines such as azelastine and cromolyn sodium actually have additional mast-cell stabilising properties which means they prevent the release of inflammatory chemicals including histamine, rather than just blocking histamine from binding to its receptors, thereby reducing swelling and inflammation in the nasal passages, but they take a little longer to start taking effect than the decongestant sprays, so it is best to use them before your congestion rebounds so they can reach the places that swell.
Nasal steroids can also help break this cycle and may be effective but can have more side effects – however these are limited when only used for a short period of time. They can have an immediate effect, however they may also take from 2-4 days to start working fully.
Breaking this cycle usually takes 1-4 days depending on the severity, but it is worth it not to be dependent on nasal decongestants every day or night! Additionally decongestants like oxymetazoline and xylometazoline can also sometimes trigger a temporary loss of sense of smell and taste which can be very frustrating if you are trying to unblock your nose to be able to eat normally. One more reason to break the cycle!
In regular use to treat allergy symptoms, nasal steroids are usually effective if used every day for at least 3-4 days for up to one month. Consult your doctor before using them longer than this. They reduce inflammation and many people find them very effective but there is a risk of side effects such as irritation, paradoxical swelling, or increased risk of infection, among others. If nasal antihistamines work well enough for you without side effects, you may want to stick with them.
Ultimately every person needs to weigh their own pros and cons before deciding which kind of medication they should use – and always be sure to consult your doctor or pharmacist. With this knowledge in hand we hope you find exactly what you need to unblock your nose!