If Some Cold Medicines Don’t Work, What Should You Take for a Stuffy Nose?

So if some medicines aren’t effective, what actually works?

There are plenty of convenient alternatives for relief from a cold or flu, but the first step is to consider your symptoms: Congestion? Congestion with a runny nose?

“The most important thing is for people to always think about, ‘What is going on? What am I feeling?’ That helps you understand what’s best for you,” said Sterling Elliott, a clinical pharmacist and assistant professor of orthopedic surgery at Northwestern University Feinberg School of Medicine.

Then, read the label: “People just trust that if it says cold or sinus, it will work,” said Dr. Purvi Parikh, an allergist and immunologist with NYU Langone Health. She recommends looking for phenylephrine on packages and “avoid it if you see it. You’re wasting your time and money.”

Here are some medicines doctors and pharmacists recommend to relieve nasal congestion:

Pseudoephedrine

There is one medicine that is the time-honored standard for relieving congestion from cold and flu: Pseudoephedrine. The decongestant shrinks blood vessels in the nasal area and prevents blood from flowing into them, stopping the congestion.

“We know that it works because when people take it they certainly report benefit and relief,” said Elliott.

This isn’t the medicine that researchers say doesn’t work, though the names sound a bit similar, which has caused some consumer confusion. Pseudoephedrine does provide relief of nasal stuffiness, studies say. The other ingredient, phenylephrine, has been shown to be no better than a placebo.

Pseudoephedrine shouldn’t be used for more than a few days at a time, and might not be safe for people with certain health conditions, because it can increase heart rate and blood pressure, say doctors and pharmacists. Pseudoephedrine is limited to people aged 12 years and older.

Sudafed Sinus Congestion, made by Kenvue , is one medication with pseudoephedrine.

The ingredient is only available behind the pharmacy counter and customers must present an ID when purchasing it, according to rules meant to prevent diversion for use in making illegal methamphetamine. But it is quick and easy to obtain, says Randy Hatton, pharmacist and professor at the University of Florida.

He bought some the same day the FDA advisory panel met to discuss phenylephrine, just to test how long it would take. “It took less than five minutes,” he said.

Decongestant sprays

Phenylephrine—the ingredient that was deemed ineffective in oral cold medicines—can be effective if it is administered as a nasal spray, although it is short-acting, doctors and pharmacists say. The downside of phenylephrine in a spray is that congestion can return, a so-called rebound, and the medication can worsen symptoms in the long run, according Parikh.

Oxymetazoline, which is sold by Bayer  under the brand name Afrin, can also help relieve congestion. A spray like Afrin “does a pretty good job of getting to those blood vessels and shrinking them the same way we want,” Elliott said.

Studies have found oxymetazoline provides both statistically significant and clinically meaningful relief of nasal congestion and improves nasal airflow for up to 12 hours following a single dose.

These sprays are recommended for no more than a few days because they can lead to a rebound. If the congestion persists, doctors say people should see a doctor to determine whether there is something structural going on.

Other sprays

Nasal steroid sprays, which are usually for allergic rhinitis, can also help with congestion by decreasing inflammation directly in the nasal passageway. These include fluticasone, which is sold under the brand name Flonase and made by GSK, and mometasone, which is sold as Nasonex by Perrigo.

Another example is triamcinolone, which is sold under several brand names. “My first go-to for many cases are more nasal sprays, especially when you’re dealing with congestion,” said Dr. Frederick Davis, the associate chair of emergency medicine at Long Island Jewish Medical Center, part of Northwell Health in New York.

Antihistamines

Antihistamines, administered by mouth or nasal passageways, aren’t decongestants but are helpful because they can reduce drainage and a runny nose. They block the release of histamines, the chemicals in cells that cause symptoms of allergies.

“If you are blocking some of this histamine release that brings with it all this extra fluid, you’re reducing the chance of swelling, you’re reducing a lot of the irritation that can occur to areas like the nasal passageways. So the hope is that by doing that, you’re also reducing the congestion you might have,” said Davis.

Twenty-four-hour antihistamines such as Kenvue’s Zyrtec, Bayer’s Claritin and Sanofi’s Allegra don’t lead to rebounds and tend to keep people from becoming drowsy, unlike some other medications. They also help open up the nasal passageways, like other antihistamines by blocking histamine release that brings with it all this extra fluid, said Davis.

Antihistamines with names that end with the letter ‘D’ such as Claritin-D, shouldn’t be taken for more than three to five days at a time because they contain pseudoephedrine, said Parikh.

Nasal antihistamines can work faster than nasal steroids, and they are also helpful at stopping runny noses, said Parikh. They can be taken with nasal steroid sprays, she said.

“The two together work very well,” Parikh said. One example of a nasal antihistamine is Bayer’s Astepro, or azelastine. “Those are safe because they don’t cause rebound congestion and they don’t damage the inside of your nose,” she said.

Combo-ingredient products

Many products that contain phenylephrine are combination medicines with other ingredients and are advertised to provide help beyond congestion. These products might still be helpful for things besides congestion. Benadryl, for example, contains an antihistamine that helps with itchy throat and watery eyes.

But pharmacists and doctors recommend people seeking congestion relief stick with the combination products that contain pseudoephedrine.

Neti pots

Nasal irrigation devices, known as neti pots, are over-the-counter remedies and designed to clear out the nasal pathway with saline solution. There might be a modest effect on nasal symptoms, said Hatton. He said the key is the solution being prepared correctly—salt is mixed with sterile or boiled water—and avoiding using tap water, which isn’t sterile and potentially carries bacteria or amoebas that could cause serious or life-threatening infections.

“Sometimes with the neti pot, as you’re flushing out, you’ll see the yellowish or greenish mucus come out the other end and they kind of feel that that is like, ‘Oh, this is working,’ ” said Davis.

What about kids?

Children who are congested could use a simple saline nasal spray, oxymetazoline nasal spray, or a nasal irrigation such as a neti pot, said Dr. Brian D’Anza, associate professor of rhinology and sinus surgery, and attending physician of the Ear, Nose and Throat Institute at University Hospitals in Cleveland.

For children under two years old, parents should use a suction device that can remove mucus. Then pain relievers could be given to help reduce inflammation.

Dosage is an important factor in deciding what medicines children should take, and parents should consult with their pediatricians, say pharmacists and physicians.