Quick Answers
There are several over-the-counter decongestants that may provide relief from nasal congestion if you have COVID-19. Some of the most commonly recommended options include:
- Pseudoephedrine (Sudafed) – This is considered the most effective oral decongestant available.
- Phenylephrine – Available in brands like Sudafed PE, this may also provide nasal decongestion but is less potent than pseudoephedrine.
- Oxymetazoline (Afrin) – This nasal spray works quickly to relieve congestion but should only be used for 3 days due to the risk of rebound congestion.
- Saline nasal spray – Saline spray hydrates the nasal passage to wash out mucus and relieve congestion.
- Guaifenesin – This oral medication may thin mucus secretions to relieve congestion.
When treating COVID-19 symptoms at home, be sure to get plenty of rest and stay hydrated. Most mild congestion can be managed with conservative measures, but contact your doctor if symptoms worsen or persist beyond 10 days.
How Decongestants Work
Nasal decongestants work by constricting blood vessels in the nasal passages, which reduces inflammation and swelling that causes congestion. There are two main types of decongestants:
- Oral decongestants – Taken by mouth in pill or liquid form, oral decongestants include pseudoephedrine and phenylephrine. They constrict blood vessels systemically.
- Nasal decongestant sprays – Sprayed directly into the nose, topical decongestants like oxymetazoline work locally on nasal blood vessels.
By making blood vessels narrower, less fluid is able to accumulate in the swollen nasal passages. This results in an improvement in breathing and congestion relief. However, both oral and nasal decongestants carry some risks if used improperly, so it’s important to choose the right option and use it correctly.
Pseudoephedrine for COVID Congestion
Of all the oral decongestants available over-the-counter, pseudoephedrine (Sudafed) is typically recommended as the first choice for relieving nasal congestion from COVID-19 or other respiratory infections like the common cold or flu.
Pseudoephedrine works by activating alpha and beta receptors that stimulate the constriction of blood vessels in the nasal passages. This reduces inflammation and nasal obstruction to improve air flow and breathing.
Research shows that pseudoephedrine provides faster and more effective relief from nasal congestion than oral phenylephrine.
One study tested the effects of a single dose of pseudoephedrine (120 mg) vs phenylephrine (10 mg) in people with nasal congestion from the common cold. Pseudoephedrine provided greater improvement in nasal air flow and decongestant effects within the first 4 hours compared to phenylephrine.
The recommended dosage for adults and children over 12 years old is 120 mg of pseudoephedrine every 4 to 6 hours. It’s important not to exceed the recommended dosing, as high doses can increase side effects.
Potential side effects may include:
- Increased heart rate and blood pressure
- Insomnia
- Nervousness
- Dizziness
- Headaches
Pseudoephedrine should not be used by people with high blood pressure, heart disease, diabetes, hyperthyroidism, or prostate issues. It’s important to speak with your doctor before using this decongestant if you have any medical conditions.
Pseudoephedrine Interactions
There are some important interactions to be aware of with pseudoephedrine:
- May interact with antidepressant MAOIs like isocarboxazid and phenelzine
- Should not be combined with stimulant drugs like amphetamines, cocaine, and other decongestants
- May alter effects of hypertension medications
Always check for potential pseudoephedrine interactions with your doctor or pharmacist if you take any other medications.
Phenylephrine for Congestion Relief
Phenylephrine is another oral decongestant available over-the-counter in products like Sudafed PE. It can provide relief from nasal congestion but is less potent than pseudoephedrine.
Phenylephrine works similarly to pseudoephedrine by constricting blood vessels in the nasal passages. However, it is selective for alpha receptors while pseudoephedrine activates both alpha and beta receptors. This results in a more modest vasoconstrictive effect compared to pseudoephedrine.
While it may take longer to work, phenylephrine is a reasonable option for treating nasal congestion if you cannot use pseudoephedrine.
The FDA approved dosage for adults and children over 12 years old is 10 mg every 4 hours as needed. Do not exceed 60 mg in 24 hours.
Potential side effects of phenylephrine include:
- Increased heart rate
- Headaches
- Dizziness
- Restlessness
- Difficulty sleeping
Phenylephrine should be avoided by people with heart disease, high blood pressure, diabetes, enlarged prostate, or glaucoma. It has fewer drug interactions compared to pseudoephedrine.
Oxymetazoline Nasal Spray
Oxymetazoline is a topical nasal decongestant found in products like Afrin. It can provide fast relief from nasal congestion but should only be used for up to 3 days.
When sprayed directly into the nose, oxymetazoline constricts blood vessels locally in the nasal passages. This quickly shrinks the swollen nasal membranes that block airflow, resulting in cleared nostrils and relief from congestion.
Oxymetazoline typically takes effect within minutes. The recommended dosage for adults and children over 6 years old is 1 to 2 sprays per nostril up to 3 times per day.
While oxymetazoline nasal spray offers fast congestion relief, rebound swelling can occur if used for more than 3 days consecutively. This can worsen nasal obstruction. To prevent this effect, do not use oxymetazoline for more than 3 days.
Side effects may include:
- Rebound congestion
- Dryness
- Headache
- Burning inside the nose
This nasal decongestant should be avoided by people with heart disease, high blood pressure, diabetes, enlarged prostate, or glaucoma. It has few drug interactions.
Saline Nasal Spray
Saline nasal spray is a safe alternative for relieving nasal congestion from COVID-19 or other viral respiratory infections. The saltwater solution helps thin mucus secretions and flush viruses and bacteria from the nasal passages.
Using a saline nasal spray can provide the following congestion benefits:
- Hydrates the nasal lining to reduce swelling
- Loosens thick mucus secretions for clearing by blowing nose
- Cleanses nasal passages of allergens, viruses, and bacteria
- Moisturizes dry nasal cavities and prevents crusting
Saline sprays are well tolerated, non-medicated, and can be used frequently throughout the day for keeping nasal passages moist. Typical dosing is 1 to 2 sprays per nostril as needed.
This can be combined with pseudoephedrine or other oral decongestants to provide extra congestion relief. Saline spray is safe for pregnant women and children to use for nasal stuffiness.
Guaifenesin
Guaifenesin is an oral expectorant medication that is sometimes used to try to thin nasal mucus secretions during respiratory infections. It is found in some over-the-counter cold medicines such as Mucinex and Robitussin.
While study results are mixed on its effectiveness, guaifenesin is thought to work by drawing water into the mucus, which helps thin secretions for easier clearing by blowing nose or coughing up phlegm.
Typical dosing of guaifenesin for adults is 200-400 mg every 4 hours as needed. It should not be used in children under 12 years old.
Potential side effects include:
- Nausea
- Dizziness
- Headache
- Stomach pain
Guaifenesin may thin mucus secretions, but it has limited ability to relieve nasal congestion. It is sometimes combined with pseudoephedrine or phenylephrine. Those with chronic cough or excessive mucus production may see the most benefits.
Natural Remedies
In addition to over-the-counter medications, there are some natural remedies that may help relieve nasal congestion during COVID-19 or colds:
- Steam inhalation – Breathing warm, humidified air loosens mucus to clear nasal passages.
- Stay hydrated – Drinking plenty of fluids keeps mucus secretions thin.
- Chicken soup – Hot liquids can soothe sinuses, and chicken soup may have anti-inflammatory effects.
- Spicy foods – The heat from spicy foods like peppers, garlic, and horseradish can temporarily help open nasal passages.
- Neti pot rinses – Rinsing sinuses with a saltwater solution can flush out mucus and congestion.
While these remedies may temporarily relieve symptoms, oral or nasal decongestants are usually more effective congestion treatments. Discuss natural remedies with your doctor to determine if they may be helpful for your stuffy nose.
When to See a Doctor
Mild nasal congestion from COVID-19 or a common cold can often be managed at home without medical treatment. However, contact your doctor if any of the following occur:
- Symptoms last more than 10 days
- Congestion is accompanied by facial pain or pressure
- You have recurrent nosebleeds or yellow/green nasal discharge
- Symptoms worsen or you develop shortness of breath or fever
- Your doctor can determine if prescription nasal steroid sprays or antibiotics are needed for sinus infections or severe nasal inflammation.
While congestion and runny nose seem mild, they can sometimes indicate more serious conditions like pneumonia or bronchitis during COVID-19 illness.
Key Takeaways
- Pseudoephedrine (Sudafed) provides the most effective nasal decongestion but can raise blood pressure.
- Phenylephrine (Sudafed PE) is less potent yet still relieves congestion with less side effects.
- Oxymetazoline nasal spray (Afrin) works fast but should only be used for 3 days.
- Saline spray hydrates and clears mucus from nasal passages.
- Guaifenesin may thin mucus but has limited decongestant effects.
- See a doctor if congestion lasts more than 10 days or gets worse.
The Bottom Line
Nasal congestion and stuffiness are common symptoms of COVID-19. While extremely clogged nostrils can be uncomfortable, most mild to moderate congestion can be managed at home with oral decongestants like pseudoephedrine or phenylephrine, nasal sprays, hydration, steam, and other remedies.
However, chronic or worsening congestion may require medical treatment. Contact your doctor if your stuffy nose persists beyond 10 days, causes facial pain/pressure, or is accompanied by discolored discharge, nosebleeds, fever, or trouble breathing.
Providing relief from a stuffy nose will help you breathe and rest easier as you recover from COVID-19 illness.
| Decongestant | Dosage | Duration | Considerations |
|---|---|---|---|
| Pseudoephedrine (Sudafed) | 120 mg every 4-6 hours | Up to 5 days | Most effective oral decongestant but can increase blood pressure and cause insomnia |
| Phenylephrine (Sudafed PE) | 10 mg every 4 hours as needed | Up to 5 days | Less potent but still effective with less side effects |
| Oxymetazoline (Afrin) | 1-2 sprays per nostril up to 3 times/day | 3 days max | Use no more than 3 days to avoid worsening rebound congestion |
| Saline nasal spray | 1-2 sprays per nostril as needed | No duration limit | Safe and non-medicated option to hydrate nasal passages |
| Guaifenesin (Mucinex) | 200-400 mg every 4 hours | Up to 5 days | May thin mucus but limited decongestant effects |