DEAR MAYO CLINIC: I have used decongestants over the years when I'm ill, but my doctor recently said that I should be cautious because nonprescription decongestants can have significant side effects. Is this true?

ANSWER: While many people rely on nasal decongestants to help ease nasal symptoms of a cold or flu, these medications can sometimes cause more harm than good, especially if used improperly or taken by patients who shouldn’t use them.

Examples of commonly used decongestants include phenylephrine and pseudoephedrine.Often these ingredients are included in multisystem cold and flu preparations. Due to the nature of medications, it is important to always read label ingredients for medications and warnings on boxes to know what you are taking and whether it is the correct product, especially if you have certain medical conditions or take other medications or supplements.

Taking an oral decongestant can temporarily ease congestion, but it also can create an increase in your blood pressure and blood sugar, aggravate glaucoma or urinary conditions, increase seizure risk, and affect heart conditions. If you already have one of these conditions, especially if it’s not controlled, this may be a concern. Decongestants can interfere with the effectiveness of certain blood pressure, epilepsy, heart, diabetes or thyroid medications, but also may affect the chronic condition itself. If you have any of the above conditions, check with your primary health care provider or pharmacist before taking an oral nasal decongestant.

Some other common side effects that nasal decongestants can cause include insomnia, nervousness, anxiety and tremor. Side effects are usually more common as the dose is increased. Oral decongestants should never be taken with monoamine oxidase inhibitors (MOAIs) or within two weeks of stopping them. MOAIs are used for Parkinson’s disease, anxiety and depression. Also avoid excess caffeine or herbal supplements while taking oral decongestants, as they may increase the risk of side effects through drug interaction. Those who may be taking amphetamines for attention deficit, hyperactivity or weight loss are at higher risk of side effects and should not take oral decongestants without speaking to their health care provider or pharmacist.

In addition, using nonprescription decongestant nasal sprays for more than three or four days can cause worse nasal congestion once the decongestant wears off, a condition called rebound rhinitis. All too often, people think their colds are getting worse, so they increase their use of nasal spray, leading to a downward spiral of more medication use and worsening congestion. The way to reverse rebound rhinitis is to stop the nasal spray in one nostril until that nostril is clear, then stop it in the other nostril and that nostril should clear, as well. Other occasional side effects of nasal sprays may include nosebleeds, headache and rapid heartbeat in susceptible patients. Some prescription medications can cause congestion, but this is uncommon.

It is important to note that children are more prone to side effects from decongestant nasal sprays and may experience sedation, agitation and even, in rare cases, seizures. Keep in mind that other over-the-counter nasal sprays help with nasal congestion indirectly, but are not decongestants. Sprays containing fluticasone, budesonide or triamcinolone are corticosteroids and work differently by overall lessening your nasal passage reaction to allergens. When nasal sprays are dosed, they should be directed away from the septum, or nose center, to help avoid nosebleeds. This can be accomplished by using the right hand to spray the left nostril and left hand to spray the right nostril.

Other factors to consider are products with decongestants that also contain antihistamine, dextromethorphan guaifenesin and acetaminophen. The acetaminophen can add to the daily limit of this medication to cause liver toxicity, while antihistamines can add to urinary conditions, aggravate asthma or other lung conditions, and should not be taken by those with glaucoma. Dextromethorphan can interact with antidepressants. In addition, common energy drinks can contain caffeine or other stimulants, and may contain herbal supplements that interact with decongestants and worsen some medical conditions or increase side effect risk.

Thankfully, symptoms usually last no more than a week and a half. If you have continued congestion, it may be time to visit your health care provider to explore treatment options that may be more effective. It is always best to speak to your primary health care provider before starting new medications. — Michael Schuh, Pharm.D., R.Ph., Pharmacy, Mayo Clinic, Jacksonville, Florida

The post Mayo Clinic Q and A: Decongestants can sometimes cause more harm than good appeared first on Mayo Clinic News Network.

But Dr. Alexei Gonzalez Estrada, a Mayo Clinic allergy specialist, says most won't get as much relief from that spray as they expect.

The reason: They're doing it wrong.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:59) is in the downloads. Read the script.

"So one of the biggest things that I see when a patient comes to see me where they were referred by a primary care is that they don't know how to use their nasal sprays correctly," says Dr. Gonzalez Estrada.

He explains that when you don't use a nasal spray correctly ...

"... if you're spraying up into your nose, you're going to be spraying your septum or your nasal bone here, and that actually thins the skin," he says. "That's one of the side effects of using a nasal spray is actually bleeding. So that's because they were using it incorrectly."

So what is the correct way to use nasal spray so you get allergy relief without the bleeding?

"You have to shake it and make sure it comes out, and you're going to tilt your head down like this," he says while demonstrating. "And what happens is most people go up like this, and that's just going to actually just spray your bone in the nose here. You actually want to aim toward the ear like this. Spray, snort slowly, shake it again, aim toward the ear, spray, snort slowly."

And if you learn the proper technique, Dr. Gonzalez Estrada says you're much more likely to get the allergy relief you are hoping for.

The post Mayo Clinic Minute: Combat allergies like a pro by learning how to use your nasal spray properly appeared first on Mayo Clinic News Network.

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DEAR MAYO CLINIC: I’ve heard that nonprescription decongestants can have significant side effects. Is this true?

ANSWER: While many people rely on nasal decongestants to help ease symptoms of a cold or flu, these medications can sometimes cause more harm than good, especially if taken repeatedly. Examples of commonly used decongestants include phenylephrine and pseudoephedrine. Often, these ingredients are included in multi-symptom cold and flu preparations, such as Maximum Strength Mucinex D, Robitussin Multi-Symptom Cold, and Tylenol Sinus Congestion & Pain.

Taking a decongestant can temporarily ease congestion, but it can also create a slight increase in your blood pressure. If you already have high blood pressure, especially if it’s not controlled, this may be a concern. Decongestants also can interfere with the effectiveness of certain blood pressure medications. If you’re on blood pressure medication, check with your doctor or pharmacist before taking a nasal decongestant.

Extended-release decongestants may be less likely to raise blood pressure than the immediate-release kind but can still cause problems. People who have conditions such as diabetes, benign prostatic hyperplasia (BPH), ischemic heart problems, thyroid disorders, glaucoma and seizures generally should avoid using nasal decongestants.

In addition, using nonprescription decongestant nasal sprays (Afrin, Dristan, others) for more than three or four days can cause even worse nasal congestion once the decongestant wears off (rebound rhinitis). All too often, people think their colds are getting worse, so they increase their use of nasal spray, leading to a downward spiral of medication use and worsening congestion. Other occasional side effects of nasal sprays may include nosebleeds, agitation and insomnia.

Thankfully, symptoms usually last no more than a week and a half. If you have continued congestion, it may be time to visit your doctor to explore treatment options that may be more effective. (adapted from Mayo Clinic Health Letter) — Lisa Buss Preszler, Pharm.D., R.Ph., Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minn.

The post Mayo Clinic Q and A: Decongestants sometimes cause more harm than good appeared first on Mayo Clinic News Network.

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