Before we get started discussing your options for sinus congestion treatment, I wanted to let you know that I was able to take my own advice from my very first post and take advantage of a manufacturer coupon. My Doctor prescribed Nexium for me. My copay for 90 capsules was $308. I used the coupon I found online at www.nexium.com and it was reduced to $30! These things really work! If you haven’t read that post yet, go do so now. You will be glad you did. Well, read this first, then read the other post.
How do you know if you have sinus congestion? It is most commonly characterized by a buildup of pressure in your sinuses, under your eyes, or in your ears. Sometimes your ears will feel like they are clogged and your hearing may be affected. There are several reasons why you might be suffering from sinus congestion. Most commonly, it is due to either a sinus infection, a cold, or allergies. I get asked a lot about what is the best sinus congestion treatment. Let’s talk about your options.
Psuedoephedrine (Sudafed) – This is probably the most commonly used sinus congestion treatment, and for good reason. It works. I won’t bore you with the mechanism of action, but it helps to shrink back that inflammation so you can breathe better and feel less pressure throughout your sinus cavities and ears. It comes in a 4-6 hour formulation, usually known as “the little red tablets”. It is also available in a 12 or 24 hour formulation and is used in many different combination products. One of the most effective combinations is Advil Cold and Sinus. It adds Advil to the psuedoephedrine to help with the pain associated with sinus pressure.
There are some drawbacks to using pseudoephedrine. One drawback is that it can be hard to get. It is only sold behind the counter at the pharmacy and federal law limits how much you can purchase on a daily and monthly basis. I will cover the details on that in my next post. Another problem is that it can raise your blood pressure. If you have blood pressure problems then you must be careful when you take this. It is probably ok to use for a few days if you have a cold or an infection, but I wouldn’t recommend it for long-term use. If you do take it, be sure to monitor your blood pressure often and discontinue if your pressure gets too high. Lastly, it can have a stimulant effect which can affect your ability to sleep. Because of this, you probably don’t want to take it at night.
Phenylephrine – This is the over the counter answer for patients who don’t want to mess with giving their personal information to the pharmacy every time they have sinus problems. Phenylephrine is not as effective as psuedoephedrine so there are not many cases in which I would recommend it’s use. It is safer for patients with high blood pressure, so I do believe it is a good alternative for those patients. They will still need to monitor their blood pressure for any changes while taking phenylephrine. This is the only sinus decongestant used in products you will find on the cough and cold aisle at the store.
Saline – Saline nasal sprays and rinses are very effective when used for sinus congestion treatment. You will see a lot of different names for the sprays such as Ocean Spray or Simply Saline. They are all the same, so don’t waste your time trying to figure out which is better. Saline adds moisture throughout your sinuses and can also flush out irritants that could be causing inflammation. It can be used frequently throughout the day if needed, and is free from worry about interactions with other medications. There is also no concern with the high blood pressure crowd. Saline is great for kids. Be ready for a fight, but it is your best option to clear their little noses.
If you are feeling adventurous, you can try a Neti Pot. Neti Pots allow you to put the saline in through one nostril, rinse the entire sinus cavity, and the saline will actually exit through your other nostril. I haven’t personally tried this, but I have a lot of patients who swear by it. There are plenty of videos on You Tube that show you how to use these devices if you need more information. Maybe I will even make one for you. Maybe not.
Steroid Nasal Sprays – (Flonase, Nasacort AQ) – Steroid nasal sprays are extremely effective but a lot of people don’t know about them. This is probably because they were prescription only until just over a year ago. Steroids work great for inflammation of mucous membranes. The spray mechanism allows you to put the steroids right on the place where you are having a problem without too much concern about causing systemic problems or side effects. They take a little longer to work than other treatments. You won’t see the peak effectiveness for 2-3 days but the payoff is worth it. Because of the slow onset, they are most effective for predictable, seasonal-type allergies. Steroid sprays must be used every day to be the most effective. Breathe in slowly and deeply when using steroid sprays but be careful not to sniff too hard and carry the spray all the way into your lungs. It won’t help you there.
I prefer Nasacort AQ over Flonase because it doesn’t have a scent or taste. Rhinocort Aqua will also be available over the counter soon.
Afrin – Here is your big gun. If you are in distress, can hardly breathe through your nose at all, have lots of pain under your eyes and in your ears, and your ears feel like you are under water, this is your answer. Temporarily. Use 1 or 2 sprays in each nostril and you will feel relief in minutes. It can be a good strategy to use Afrin to open things up and then use your steroid or saline afterward.
There are several big warnings with Afrin. Most importantly, it can cause rebound congestion if you use it for too long. What this means is that your congestion will be worse when you discontinue treatment, and you basically won’t be able to breathe at all unless you keep taking it. Because of this rebound, you want to limit use to 1 or 2 days only. I only use it 1 dose at a time and only when my sinuses are as bad as they can get. I can’t stress this enough: save it for when you really need it.
Other side effects include increased blood pressure and stimulation that could interfere with sleep. This is a good medication but it must be used properly and with caution. There are many different formulations. They all have the same active ingredient. Extra moisturizing, no drip, 12 hour, whatever. That is mostly just marketing. They will all work the same.
I won’t get into all of the combination products. The ones listed here are the best when searching for an effective sinus congestion treatment. Please leave me a comment if you have an experience to share or if you have a question.