Antihistamines and decongestants are two of the largest groups of treatments for sinusitis.
Understanding the differences between these two broad classes of medications can help you use them most effectively. In a previous entry, I discussed antihistamines. Let's now look at how best to use decongestants.
Decongestants do exactly what the name implies - reduce the congestion. They won't block histamine (the trigger for new mucus formation), but will help to dry things up while they're in your system.
These medications have a similar effect to that of adrenaline, which is the main signal of our body's "fight or flight" response - but to a milder degree. To better understand this, think about how dry your mouth feels when you are stressed, anxious, or afraid. That drying effect can be just what the doctor ordered if you have a nose (or sinuses) full of mucus.
The side effects of decongestants also make sense within this "fight or flight" context. The most serious ones are increases in blood pressure and heart rate, which are two key responses from your body during an emergency. So don't be surprised if your decongestant causes a racing heartbeat, and avoid these medications if you have high blood pressure.
Other common side effects of decongestants, which also make sense in a "fight or flight" situation, are agitation, difficulty sleeping, and difficulty passing urine. They can also reduce your appetite, but they should never be used as a diet aid.
Have you ever noticed that you feel less congested while exercising? That's because the simplest and most natural decongestant is adrenaline, which your body produces when you exercise. (As a side note, exercise can also cause or worsen a runny nose, because it increases blood flow inside and around the nose, especially in cold temperatures.)
Caffeine is also a decongestant - have you ever had palpitations or insomnia from too much caffeine? A steaming hot cup of coffee or tea really does help to clear out a stuffy head.
Most decongestant medications (both over the counter and prescription) contain phenylephrine. Another decongestant, pseudoephedrine, is a bit more potent and is available without a prescription, but you must personally ask your pharmacist for it because it can be used as an ingredient in the production of illicit drugs. Many medications indicate that they contain a decongestant by putting a "D" at the end of the name.
Oxymetazoline is a decongestant available over the counter, as both a nasal spray and eye drops. This product works quickly to dry up a runny nose or watery eyes, and has fewer side effects than the oral medications.
However, most people experience a powerful "rebound effect" when it wears off - with even more mucus production or eye watering than before the first dose was taken. After two or three days of oxymetazoline use, many people find it very difficult to discontinue this medication, so I generally advise against starting on it at all.
Like antihistamines, decongestant medications can be taken just as needed or on a regular schedule. However, the side effects of the decongestants are typically greater than those of the antihistamines, so most people find it best to use them sparingly, and only when symptoms are deemed bad enough to be worth treating.
