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Health Education

The best medicine for congestion

Learn which OTC medication will help clear your congestion based on the associated symptoms
Gerardo Sison medical writer headshot
By | Jan. 4, 2023
Hand holding rx pills: Types and uses of medicine for congestion

Key takeaways

  • Congestion, often resulting from allergies or respiratory infections, can be effectively treated with various over-the-counter medications including oral and nasal decongestants, nasal steroid sprays, and antihistamines, but it’s advisable to consult a healthcare provider for the best treatment option.

  • Oral and nasal decongestants, such as Sudafed and Afrin, quickly reduce swelling in nasal passages to alleviate congestion, but should be used with caution due to potential side effects like increased blood pressure and the risk of rebound congestion from decongestant nasal sprays if used for more than three days.

  • Antihistamines block the effects of histamine to relieve symptoms caused by allergies, with second-generation antihistamines like Claritin, Zyrtec, and Allegra causing fewer side effects such as drowsiness compared to first-generation antihistamines like Benadryl.

  • Home remedies for congestion include staying hydrated, using humidifiers, taking hot showers, and employing saline nasal drops or breathing strips, which can be used alongside OTC medications to help relieve symptoms.

In this article:

Congestion or stuffiness can often occur due to allergies or a respiratory infection like the common cold. While it’s not generally a cause for alarm, congestion can be bothersome and interfere with daily activities. It can also be accompanied by other symptoms like a runny nose, itchy eyes, and a cough. Luckily, there are many different treatment options available for congestion that are easily accessible over the counter. 

Because there are different types of medicines for congestion, it can sometimes be hard to choose the best option. These medication options include oral and nasal decongestants, nasal steroid sprays, and antihistamines. In any case, it’s always a good idea to check with a doctor or pharmacist to find the best treatment option for congestion, especially if other symptoms are present. One medication may be better than another, depending on the cause of the congestion. 

Continue reading to learn more about the types of medications available for congestion.

Types of medications for congestion

Congestion occurs due to inflammation in the nasal passages, which can make it hard to breathe normally. Medications can work in different ways to treat congestion and vary in cost, side effects, and how they’re administered. For example, some medications can be administered as oral tablets, nasal sprays, or both. These medications are typically available as over-the-counter medicines that can be purchased as brand or generic drugs. Although they’re usually affordable, OTC medications can be expensive, especially in high quantities or strengths. Using a prescription discount card may help save on the cost of these medications.

Decongestants 

​​Oral and nasal decongestants are one of the most popular options for congestion. They work by narrowing the blood vessels in the nasal passages to reduce swelling and inflammation that leads to congestion. Oral decongestants include Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine). Sudafed comes as an immediate-release pill that lasts for around four to six hours and an extended-release version that lasts for 12 or 24 hours. Oral decongestants start working quickly within 30 minutes to an hour. 

Nasal decongestant sprays work directly in the nasal passages with effects that come on more quickly than those of oral tablets, usually within minutes. However, decongestant sprays shouldn’t be used for longer than three days due to the risk of rebound congestion. Therefore, decongestant sprays are only recommended for short-term relief. Examples of decongestant nasal sprays include Afrin (oxymetazoline), Otrivin (xylometazoline), and Privine (naphazoline).

Side effects of decongestants include increased high blood pressure, fast heart rate, and trouble sleeping (insomnia). People with a history of uncontrolled high blood pressure, heart disease, thyroid disease, or diabetes should consult a healthcare provider and use decongestants with caution.

Antihistamines 

Antihistamines are a class of drugs that can be used to help relieve nasal congestion, runny nose, and sneezing caused by allergic rhinitis or hay fever. They’re not generally used for symptoms of the common cold or flu. Antihistamines work by blocking the effects of histamine after contact with an allergen like dust mites, pollen, or pet dander. They’re usually taken as an oral tablet, capsule, or liquid solution for allergies, and they can be purchased over the counter in brand and generic forms. Antihistamines generally start working quickly within 30 minutes and can provide relief for up to 24 hours. 

Antihistamines are split into two main groups: first-generation antihistamines, including Benadryl (diphenhydramine), Vicks Nyquil (doxylamine), and Dimetapp (brompheniramine), and second-generation antihistamines, including Claritin (loratadine), Zyrtec (cetirizine), and Allegra (fexofenadine).

Side effects of antihistamines include drowsiness, dizziness, and dry mouth. However, First-generation antihistamines tend to cause more drowsiness than second-generation antihistamines. Older people may need to use antihistamines with caution due to an increased risk of falls, which can lead to bone fractures. In addition, people with a history of seizures, glaucoma, or an enlarged prostate should use antihistamines with caution due to potentially worsened symptoms. 

Steroid nasal sprays

Corticosteroid or steroid nasal sprays are often used to relieve congestion from allergies. They work by reducing inflammation and swelling in the nasal passages, and they’re available in brand and generic versions with various active ingredients. Relief may be felt within hours of use, but it may take one to two weeks to experience the full benefits of nasal steroid sprays. For that reason, nasal steroid sprays are recommended to be started a couple of weeks before expected symptoms, such as before allergy season. In some cases, they may be used in addition to an oral antihistamine. 

Examples of steroid nasal sprays include Flonase (fluticasone), Rhinocort (budesonide), and Nasonex (mometasone). Nasal steroids are usually administered one to three times daily, depending on the medication. 

Side effects of steroid nasal sprays may include irritation, burning, or dryness in the nose after use, as well as headache, nausea, and throat irritation. Systemic side effects are less likely with nasal steroids than with oral steroids. However, they are still possible, especially with long-term use or high dosages. These side effects include increased blood sugar levels, mood changes, high blood pressure, increased appetite, and weight gain. Other serious side effects include Cushing’s syndrome, increased risk of infections, decrease in bone density, and stomach ulcers. 

Pain relievers 

Although they don’t directly relieve stuffiness and congestion, OTC pain relievers can help relieve sinus pain or discomfort that occurs along with congestion. Pain relievers like Tylenol (acetaminophen) or Advil (ibuprofen) may help relieve discomfort, headache, or pain caused by congestion. These pain relievers also have antipyretic effects that can help reduce a fever, a symptom that can often accompany congestion. Acetaminophen is believed to work by reducing certain substances involved with pain and fever; however, it does not reduce inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help decrease inflammation and reduce pain and fever.

Side effects of acetaminophen include headache, nausea, and an upset stomach. Acetaminophen also carries a risk of causing liver damage, especially when taken in high doses. While NSAIDs can cause minor side effects like acetaminophen, they can also cause serious gastrointestinal side effects, such as stomach ulcers, and cardiovascular events, such as heart attacks and strokes. 

Home remedies for congestion

Natural and home remedies can be effective options for relieving congestion caused by allergies or the common cold. Although the scientific evidence behind some of these methods is limited, there is countless anecdotal evidence supporting their use. Natural remedies include:

  • Staying hydrated can help thin mucus and moisten the nasal passages, which can help relieve congestion.
  • Getting enough sleep can help boost the immune system and allow the body to fight an underlying infection that may be causing congestion.
  • Eating a healthy diet rich in vitamins and essential nutrients can keep the body nourished while dealing with an infection. Hot tea and soup can be soothing and may help relieve a stuffy nose.
  • Supplementing with zinc may help to reduce the duration of common cold symptoms, including congestion.
  • Taking a hot shower can help thin mucus and relieve a stuffy nose via breathing in steam.
  • Using a humidifier or vaporizer can also help thin mucus and make it easier to breathe with congestion. Humidifiers use ultrasonic technology to create a cooling mist, while vaporizers heat water to create streams. 
  • Aromatic oils, such as menthol, camphor, and eucalyptus, can help relieve sinus congestion and provide a soothing sensation. Brand-name products include Theraflu Vapor Patch and Vicks VapoRub. 
  • Saline nasal drops contain a solution of salt water to help clear mucus and relieve congestion.
  • Sitting upright can help improve drainage from the sinuses to reduce congestion.
  • Nasal breathing strips physically help widen the nasal passages to relieve sinus pressure. They may be particularly useful for sleep. 
  • Using a bulb syringe can help clear mucus in the nasal passages of young children who may be unable to blow their noses (younger than four years old). A Neti pot or nasal irrigator can be a similar solution for older children and adults. 

Home remedies can often be combined and implemented in addition to OTC products and cold medicines for congestion. These home remedies can help relieve not only congestion but other cold symptoms, such as a sore throat, runny nose, and cough.

When to see a doctor

Although congestion is usually a mild symptom of an illness, severe cases of congestion could indicate a serious condition or infection that needs medical attention. For example, prescription medications like antibiotics or antivirals may be needed to treat certain infections. Consult a doctor or healthcare provider if you experience any of the following, along with congestion. 

  • A high fever (103 degrees Fahrenheit or higher in adults, 100.4 degrees Fahrenheit in infants younger than three months old, or 102 degrees Fahrenheit in infants between three and six months old) 
  • Chest tightness or severe difficulty breathing 
  • Severe dizziness
  • Persistent or serious nausea and vomiting

Congestion that worsens or doesn’t seem to go away within a week to ten days should be assessed by a healthcare provider. You should also consult a healthcare provider if you have other health conditions, such as COPD or asthma, that may increase the risk of complications from an illness causing congestion. If medications don’t seem to be working to relieve congestion, or if you start experiencing severe side effects from medications for congestion, seek medical advice from a doctor or healthcare provider.