Nasal congestion
The nose stops breathing when the lining swells and its vessels dilate: this happens with a cold, allergic and non-allergic rhinitis, sinusitis, dry air or as a side effect of certain drugs. Vasoconstrictor drops clear the swelling within minutes, but used for longer than a few days they become the cause of congestion themselves. So what matters is not clearing the nose quickly but working out what blocked it.
ICD-10 R09.83 drugs
Also known as: Blocked nose, Nasal obstruction
Drugs used for this condition
- BOxymetazolineSecond line · Topical nasal vasoconstrictor, imidazoline derivativeOxymetazoline opens the nose within minutes and keeps it open for 10 to 12 hours. The AEMPS ficha técnica sets a strict schedule: adults and children over 6 years get 2 to 3 sprays in each nostril, no more than twice a day. The 2016 Cochrane review of decongestants for the common cold put the effect size in place: in adults a single dose gives small relief that patients do notice, while repeated use is studied less well and shows no advantage over placebo. The course is limited to 3 to 5 days, and that is no overcaution: beyond it drug-induced rhinitis begins. The ficha lists separately who should consult a doctor before buying – people with cardiovascular disease, hypertension, diabetes, thyroid disease and prostate enlargement.
- BXylometazolineSecond line · Topical nasal vasoconstrictor, imidazoline derivativeXylometazoline clears congestion for 6 to 8 hours. The AEMPS ficha técnica frames the indication as temporary local relief of nasal congestion: adults and adolescents from 12 years get the 1 mg/ml spray, one spray per nostril twice a day and up to three times if needed; children from 6 to 12 years have a separate 0.5 mg/ml form. The 2016 Cochrane review of decongestants showed that in adults with a cold a single dose gives small relief of breathing, while in children no benefit is visible. The practical limit is 3 to 5 consecutive days: beyond it drug-induced rhinitis begins. Before buying, the ficha advises assessment for people with heart and vascular disease, hypertension, diabetes, thyroid disease, prostate enlargement, and for those taking tricyclic or tetracyclic antidepressants.
- CPseudoephedrineSecond line · Systemic decongestant, sympathomimeticPseudoephedrine is a decongestant in tablet form: it opens the nose from inside, through the bloodstream, and is therefore used when drops do not suit or when both sides are blocked in a cold, influenza or rhinitis. The AEMPS ficha técnica sets a narrow frame: adults and adolescents from 12 years take one prolonged-release tablet every 12 hours, at most 240 mg a day, in a short course. The 2012 Cochrane review of antihistamine-decongestant-analgesic combinations for the common cold found small benefit in adults and adolescents and no benefit in younger children. Since 2023 new European restrictions apply after the EMA review: the drug is not used in severe or uncontrolled hypertension or in severe renal impairment. AEMPS asks people to stop immediately and seek help in case of sudden severe headache, seizures, confusion or visual disturbance.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit