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{{short description|Drug to relieve nasal congestion}}
{{Unreferenced|date=July 2009}}
{{about|decongestant medications|their nasal delivery system|inhaler}} {{About|decongestant medications|their nasal delivery system|inhaler}}
⚫ A '''decongestant''' (or '''nasal decongestant''') is a type of ] that is used to relieve ] in the ]. The active ingredient in most decongestants is either ] or ] (the latter of which has ]).


⚫ A '''decongestant''', or '''nasal decongestant''', is a type of ] that is used to relieve ] in the ]. The active ingredient in most decongestants is either ] or ] (the latter of which has ]). Intranasal ]s can also be used as decongestants and ]s can be used to alleviate ], ], and ].<ref name="Ficalora2013">{{cite book|author=Robert D. Ficalora|title=Mayo Clinic Internal Medicine Board Review|url=https://books.google.com/books?id=UH5pAgAAQBAJ&pg=PA579|date=28 May 2013|publisher=Oxford University Press|isbn=978-0-19-998589-0|pages=579–}}</ref>
⚫ These are ] which on topical application as dilute solution (0.05-0.1%) produce local ].
⚫ Regular use of these agents for long periods should be avoided because mucosal ciliary function is impaired: atrophic rhinitis and ] can occur due to persistent vasoconstriction.


⚫ ]s on ] as dilute solution (0.05–0.1%) produce local ].
⚫ Decongestants can be absorbed from the nose via an ] and produce systemic effects, mainly ] stimulation and rise in ]. These drugs should be used cautiously in hypertensives and in those receiving ].

⚫ Regular use of decongestants for long periods should be avoided because mucosal ciliary function is impaired: atrophic rhinitis and ] (loss of the sense of smell) can occur due to persistent vasoconstriction.

⚫ Decongestants can be absorbed from the nose via an ] and produce systemic effects, mainly ] stimulation and rise in ]. These drugs should be used cautiously in hypertensives and in those receiving ]s (MAOIs), as they can cause ].

]s such as ] are a related type of drug which help to clear ].

{{TOC limit|3}}

==Medical uses==
Decongestants are used to treat ], for instance in ], ]s like the ], ], and ], and ]s. Decongestants are also used to reduce redness in the treatment of simple conjunctivitis.

A 2016 ] ] found insufficient evidence to support the use of intranasal corticosteroids in the relief of common cold symptoms;<ref name="pmid26461493">{{cite journal | vauthors = Hayward G, Thompson MJ, Perera R, Del Mar CB, Glasziou PP, Heneghan CJ | title = Corticosteroids for the common cold | journal = Cochrane Database Syst Rev | issue = 10 | pages = CD008116 | year = 2015 | pmid = 26461493 | doi = 10.1002/14651858.CD008116.pub3 | url =https://pure.bond.edu.au/ws/files/32879677/Corticosteroids_for_the_common_cold.pdf }}</ref> however, the review was based on three trials and the quality of the evidence was regarded as very low.<ref name="pmid26461493" />


==Pharmacology== ==Pharmacology==
The vast majority of decongestants act via enhancing ] (noradrenaline) and ] (adrenaline) or ] activity by stimulating the ]s. This induces ] of the ]s in the ], ], and ], which results in reduced ] (]) and ] formation in these areas. The vast majority of decongestants act via enhancing ] (noradrenaline) and ] (adrenaline) or ] activity by stimulating the ] since they mediate vasoconstriction and constricting nasal vasculature causes decongestion of nasal mucosa. This induces ] of the ]s in the ], ], and ], which results in reduced ] (]) and ] formation in these areas.


Decongestant nasal sprays and eye drops often contain ] and are used for ]. Pseudoephedrine acts indirectly on the adrenergic receptor system, whereas phenylephrine and oxymetazoline are direct ]. The effects are not limited to the nose, and these medicines may cause ] (high blood pressure) through ]. Most decongestants, however, are not pronounced stimulants, due to lack of response from the other adrenoreceptors. Besides hypertension, common side-effects include sleeplessness, anxiety, dizziness, excitability, and nervousness. Decongestant nasal sprays and eye drops often contain ] and are used for ]. Pseudoephedrine acts indirectly on the adrenergic receptor system, whereas phenylephrine and oxymetazoline are direct ]. The effects are not limited to the nose, and these medicines may cause ] (high blood pressure) through ]; it is for this reason that people with hypertension are advised to avoid them. Most decongestants, however, are not pronounced stimulants, due to lack of response from the other adrenoreceptors. Besides hypertension, common side-effects include sleeplessness, anxiety, dizziness, excitability, and nervousness.


Topical nasal or ophthalmic decongestants quickly develop ] (''a rapid decrease in the response to a drug after repeated doses over a short period of time''). Long-term use is not recommended, since these agents lose effectiveness after a few days. Topical nasal or ophthalmic decongestants quickly develop ] (''a rapid decrease in the response to a drug after repeated doses over a short period of time''). Long-term use is not recommended since these agents lose effectiveness after a few days.


==Lists== ==List of agents==

Common decongestants include:
===Adrenaline releasing agents===
* ]
{{Main|Norepinephrine releasing agent}}
* ]

====Common or widely marketed====
⚫ * ] – controlled in some jurisdictions for over-the-counter use
* ] (Vicks VapoInhaler)
⚫ * ]
⚫ * ] (Benzedrex)
* ] (Sudafed) – controlled in some jurisdictions for over-the-counter use
** ] (Claritin-D) – also an ] via ]

====Uncommon or discontinued====
* ] (formerly sold as ], now a controlled substance in most jurisdictions)
⚫ * ]
⚫ * ]
* ]
⚫ * ]

===α-Adrenergic receptor agonists===
{{Main|α-Adrenergic receptor agonist}}

====Common or widely marketed====
* ] * ]
* ] * ]
* ] * ]
⚫ * ]
⚫ * ]
⚫ * ] — controlled in some jurisdictions for over the counter use
* ] * ]
* ] * ]
Line 30: Line 58:
* ] * ]


Uncommon or discontinued decongestants include: ====Uncommon or discontinued====
* ]
⚫ * ]
⚫ * ]
⚫ * ]
⚫ * ]
* ] * ]
* ]
⚫ * ]
* ] * ]
* ] * ]
⚫ * ]
* ] * ]

===Corticosteroids===
* ] (Beconase, QNASL)
* ] (Rhinocort)
* ] (Omnaris, Zetonna)
* ]
* ] (Nasarel)
* ]
* ] (Veramyst)
* ] (Flonase)
** ] (Dymista) – also an ] via ]
* ] (Nasonex)
* ]
* ] (Pivalone)
* ] (Nasacort)
* ] (Nasacort, Allernaze)

===Miscellaneous===

====Common or widely marketed====
* ] (])

====Uncommon or discontinued====
⚫ * ]


==See also== ==See also==
* ] * ]
* ]
* ]
* ]
* ]


==References== ==References==
{{Reflist}} {{Reflist|2}}


{{Major Drug Groups}} {{Major drug groups}}
{{Nasal preparations}} {{Nasal preparations}}


] ]
]

Latest revision as of 02:11, 13 March 2024

Drug to relieve nasal congestion This article is about decongestant medications. For their nasal delivery system, see inhaler.

A decongestant, or nasal decongestant, is a type of pharmaceutical drug that is used to relieve nasal congestion in the upper respiratory tract. The active ingredient in most decongestants is either pseudoephedrine or phenylephrine (the latter of which has disputed effectiveness). Intranasal corticosteroids can also be used as decongestants and antihistamines can be used to alleviate runny nose, nasal itch, and sneezing.

Topical decongestants on topical application as dilute solution (0.05–0.1%) produce local vasoconstriction.

Regular use of decongestants for long periods should be avoided because mucosal ciliary function is impaired: atrophic rhinitis and anosmia (loss of the sense of smell) can occur due to persistent vasoconstriction.

Decongestants can be absorbed from the nose via an inhaler and produce systemic effects, mainly central nervous system stimulation and rise in blood pressure. These drugs should be used cautiously in hypertensives and in those receiving monoamine oxidase inhibitors (MAOIs), as they can cause hypertensive crisis.

Expectorants such as guaifenesin are a related type of drug which help to clear mucus.

Medical uses

Decongestants are used to treat nasal congestion, for instance in allergies, infections like the common cold, influenza, and sinus infection, and nasal polyps. Decongestants are also used to reduce redness in the treatment of simple conjunctivitis.

A 2016 Cochrane review found insufficient evidence to support the use of intranasal corticosteroids in the relief of common cold symptoms; however, the review was based on three trials and the quality of the evidence was regarded as very low.

Pharmacology

The vast majority of decongestants act via enhancing norepinephrine (noradrenaline) and epinephrine (adrenaline) or adrenergic activity by stimulating the α1-adrenergic receptor since they mediate vasoconstriction and constricting nasal vasculature causes decongestion of nasal mucosa. This induces vasoconstriction of the blood vessels in the nose, throat, and paranasal sinuses, which results in reduced inflammation (swelling) and mucus formation in these areas.

Decongestant nasal sprays and eye drops often contain oxymetazoline and are used for topical decongestion. Pseudoephedrine acts indirectly on the adrenergic receptor system, whereas phenylephrine and oxymetazoline are direct agonists. The effects are not limited to the nose, and these medicines may cause hypertension (high blood pressure) through vasoconstriction; it is for this reason that people with hypertension are advised to avoid them. Most decongestants, however, are not pronounced stimulants, due to lack of response from the other adrenoreceptors. Besides hypertension, common side-effects include sleeplessness, anxiety, dizziness, excitability, and nervousness.

Topical nasal or ophthalmic decongestants quickly develop tachyphylaxis (a rapid decrease in the response to a drug after repeated doses over a short period of time). Long-term use is not recommended since these agents lose effectiveness after a few days.

List of agents

Adrenaline releasing agents

Main article: Norepinephrine releasing agent

Common or widely marketed

Uncommon or discontinued

α-Adrenergic receptor agonists

Main article: α-Adrenergic receptor agonist

Common or widely marketed

Uncommon or discontinued

Corticosteroids

Miscellaneous

Common or widely marketed

Uncommon or discontinued

See also

References

  1. Robert D. Ficalora (28 May 2013). Mayo Clinic Internal Medicine Board Review. Oxford University Press. pp. 579–. ISBN 978-0-19-998589-0.
  2. ^ Hayward G, Thompson MJ, Perera R, Del Mar CB, Glasziou PP, Heneghan CJ (2015). "Corticosteroids for the common cold" (PDF). Cochrane Database Syst Rev (10): CD008116. doi:10.1002/14651858.CD008116.pub3. PMID 26461493.
Major chemical drug groups – based upon the Anatomical Therapeutic Chemical Classification System
gastrointestinal tract
/ metabolism (A)
blood and blood
forming organs (B)
cardiovascular
system (C)
skin (D)
genitourinary
system (G)
endocrine
system (H)
infections and
infestations (J, P, QI)
malignant disease
(L01–L02)
immune disease
(L03–L04)
muscles, bones,
and joints (M)
brain and
nervous system (N)
respiratory
system (R)
sensory organs (S)
other ATC (V)
Decongestants and other nasal preparations (R01)
Topical
Sympathomimetics, plain
Antiallergic agents,
excluding corticosteroids
Corticosteroids
Other nasal preparations
Combination products
Systemic use:
Sympathomimetics
Categories:
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