Short Acting Nasal Decongestants
Place in Therapy
Place in Therapy
- Topical (intranasal) phenylephrine is an efficacious medication for the relief of nasal congestion, a common symptom experienced by patients presenting with allergic rhinitis. It is applied directly to the nasal mucosa via a nasal spray pump. Unfortunately, topical phenylephrine has not been shown to reduce the severity of other symptoms associated with the condition (for example, sneezing, rhinorrhea and pruritis).1 This solidifies its place as an adjunct therapy (adjunct to either first or second generation antihistamines, mast cell stabilizers or butterbur) specifically for patients experiencing congestion. It is important to note that long-term use of this medication (more than five days) can cause a phenomenon called rhinitis medicamentosa (also known as rebound congestion).1,2,3 This is an undesirable outcome for patients and therefore this medication should only be used for congestion flare-ups lasting fewer than five days.
Topical nasal decongestants (both phenylephrine and the long-acting agents xylometazoline and oxymetazoline) have less systemic absorption than oral decongestants.1 Systemic side effects (hypertension and tachycardia) seen with the oral products are rarely seen with the use of topical decongestants. Topical products are most likely more safe than the oral products in both breastfeeding and pregnancy, though there is very limited research available to support this and decongestants in general may best be avoided for these particular patients.2 The long-acting topical decongestants may be more convenient for patients because they only have to be applied every twelve hours whereas phenylephrine may need to applied every four hours to maintain congestion relief. There is more primary literature available supporting the use of the long-acting products for congestion in allergic rhinitis than topical phenylephrine.
In conclusion, topical phenylephrine may be considered for the relief of acute congestion (less than five days) in allergic rhinitis in addition to the use of antihistamines or mast cell stabilizers. Xylometazoline or oxymetazoline may be more appropriate choices as their effect lasts longer than phenylephrine. If a patient requires congestion relief for more than five days, topical decongestants should not be used (oral decongestants, saline irrigation or intranasal corticosteroids may be considered).1
References:
1. Roy H. "Allergic Rhinitis." Patient Self‐Care: Helping Your Patient Make Therapeutic Choices. 2nd ed. Ottawa, Ontario, Canada: Canadian Pharmacists Association, 2010. 171‐185.
2. Wallace DV, Dykewicz MS. The diagnosis and management of rhinitis: An updated practice parameter. J Allergy Clin Immunol. 2008 Aug; 122(2 Suppl): S1‐84.
3. Van Cauwenberge P, Bachert C, Passalacqua G et al. Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology. Allergy 2000; 55: 116‐34.