Decongestants

Definition

Decongestants are medicines used to relieve nasal congestion (stuffy nose).

Description

Decongestant drugs are chemically similar to epinephrine and norepinethrine, which are hormones that cause excitation in the body. These hormones cause constriction of blood vessels. A stuffy nose is caused by dilated blood vessels, which swell the nasal passages and make it harder to breathe.

Because these drugs have actions similar to the natural hormones, they have been used for purposes other than the treatment of nasal congestion. Some of these uses, such as treatment of hypotension, can be very important. Some of these drugs have also been abused because of their stimulant effects.

General use

A congested or stuffy nose is a common symptom of colds and allergies . This congestion results when membranes lining the nose become swollen. Decongestants relieve the swelling by narrowing the blood vessels that supply the nose. This narrowing reduces the blood supply to the swollen membranes, causing them to shrink.

These medicines do not cure colds or reverse the effects of histamines, chemicals released as part of the allergic reaction. They will not relieve all of the symptoms associated with colds and allergies, only the stuffiness.

Nasal decongestants may be used in many forms, including tablets, nose drops, and nasal sprays.

Precautions

Because decongestants have the potential for many side effects and adverse effects, they must be dosed carefully.

Side effects

When decongestants are used in the form of nose drops or nasal spray, the following adverse effects are common:

stinging
burning
sneezing
increased nasal discharge
altered sense of taste

The following adverse effects are very rare when decongestants are given by drops or spray and also quite rare but possible when given by mouth:

restlessness
anxiety
nervousness
weakness
difficulty breathing

Even more severe adverse effects are possible when decongestants are taken in large overdose. These include heart problems and tremors.

Some people complain of rebound congestion, which occurs when, after the decongestant has worn off, the congestion returns even worse than before.

Interactions

Decongestants do not have any interactions with drugs that would be taken by a generally healthy child. Even so, people using decongestants should review their drug therapy with a physician or pharmacist before starting treatment.

Although decongestants have the potential for serious side effects and adverse effects, they are very safe when used properly. However, nasal decongestants should only be used for three days at a time to avoid significant rebound effect. The most severe adverse effects can be avoided by using nose drops and nasal sprays in place of tablets or capsules.

Parental concerns

Parents administering these drugs to their children should use nose drops or nasal spray and avoid tablets or capsules, which are more likely to cause adverse effects. They should also review the proper administration of nose drops and nasal spray with a physician or nurse.

Decongestants are subject to abuse. Parents should observe the behavior of adolescents and teens who may be purposely overdosing on these drugs.

In the event of severe adverse effects, parents should get medical care immediately for their child.

KEY TERMS

Constricted —Made smaller or narrower.

Dilate —To expand in diameter and size.

Hypotension —Low blood pressure.

Tremor —Involuntary shakiness or trembling.

See also Cough suppressants ; Expectorants .

Resources

BOOKS

Beers, Mark H., and Robert Berkow, eds. The Merck Manual , 2nd home ed. West Point, PA: Merck & Co., 2004.

Mcevoy, Gerald, et al. AHFS Drug Information 2004. Bethesda, MD: American Society of Healthsystems Pharmacists, 2004.

Siberry, George K., and Robert Iannone, eds. The Harriet Lane Handbook , 15th ed. Philadelphia: Mosby Publishing, 2000.

PERIODICALS

Daggy, A., et al. "Pediatric Visine (tetrahydrozoline) ingestion: case report and review of imidazoline toxicity." Veterinary and Human Toxicology 45, no. 4 (August 2003): 210–2.

Leung, A. K., and J. D. Kellner. "Acute sinusitis in children: diagnosis and management." Journal of Pediatric Health Care 18, no. 2 (March-April 2004): 72–6.

Watanabe, H., et al. "Oxymetazoline nasal spray three times daily for four weeks in normal subjects is not associated with rebound congestion or tachyphylaxis." Rhinology 41, no. 3 (September 2003): 167–74.

ORGANIZATIONS

American Academy of Emergency Medicine. 555 East Wells Street, Suite 1100, Milwaukee, WI 53202–3823. Web site: http://www.aaem.org.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: http://www.aap.org.

WEB SITES

Allergic Child. Available online at http://www.allergicchild.com/ (accessed October 17, 2004.

HealthyMe! Available online at http://www.ahealthyme.com/topic/childrens;jsessionid=5KZUMWMWHEM12CTYAEOS4EQ (accessed October 17, 2004.)

Deanna M. Swartout-Corbeil, R.N.

Samuel Uretsky, PharmD