Your nose feels more stuffed than your favorite childhood teddy bear, so you’re perusing the aisles of your local pharmacy for a good decongestant. You see one with the active ingredient phenylephrine, but after taking it, your symptoms don’t feel that much better.
It’s not in your head — an FDA panel recently concluded that phenylephrine, a popular over-the-counter decongestant found in many cold and allergy capsules and syrups, is no better than a placebo when taken orally. It turns out your body breaks down and eliminates the ingredient before it ever gets to your nasal passages.
But there’s still hope for your nose: Plenty of other over-the-counter drugs and home remedies can treat your symptoms — and get you one step closer to a clear head.
What causes nasal congestion?
You know the drill: You catch a cold or flu, and pretty soon, you’re dealing with a runny nose, stuffed-up sinuses and mucus buildup.
Congestion might also bring some other not-so-fun symptoms, like a feeling of swelling or fullness in your face, difficulty breathing and fatigue.
“Nasal congestion is a common symptom of rhinosinusitis, which is inflammation of the nasal cavity and sinuses,” says Ashley Rizzo, a clinical pharmacist at UW Medicine.
Endless amounts of snot — nasal discharge in polite company — might be what comes to mind first when you think about being stuffed up. While it is part of the inflammatory response, it’s the swelling of your nasal tissue, or mucosa, that makes you feel clogged.
Thankfully, these symptoms are treatable if you know what to take.
How to treat nasal congestion
So how can you figure out which cold and allergy drugs work and which don’t?
First, determine the cause of your nasal congestion. Are you having a bad bout of allergies or hay fever? Are you recovering from a cold or sinus infection? Knowing the answers can direct you to the right place — and help you navigate the endless options on pharmacy shelves.
What to use when your congestion is caused by allergies
Rizzo says that for mild symptoms resulting from allergies, using an over-the-counter nasal saline spray can help remove allergens from nasal passages. Nasal sprays with corticosteroids, like Flonase or Nasacort, can also help reduce inflammation by inhibiting inflammation-associated molecules in your nose.
“Glucocorticoid nasal sprays are some of the most effective over-the-counter agents for relieving mild, moderate or severe sinus congestion, and typically have minimal adverse effects when used at recommended doses,” says Rizzo.
One downside? These kinds of corticosteroids may take several days to several weeks to work, so they're better suited for prolonged seasonal allergies.
Whichever spray you choose, you’re likely going to get better results than a pill. “Generally speaking, these nasal sprays work better to improve congestion than oral antihistamines,” says Rizzo.
What to use when your congestion is caused by a virus
Other types of nasal sprays, such as those with the main ingredient oxymetazoline (think Afrin), work by constricting blood vessels in your nasal passages, which reduces swelling in your nose’s mucosa and gives you much-needed relief.
These types of nasal sprays are most effective for stuffiness caused by a cold or the flu, though they can also be used to treat allergy-related nasal congestion. Rizzo says these kinds of drugs should only be used for three days or fewer — overuse can cause a rebound effect in which the swelling returns and sometimes persists.
Pseudoephedrine, which is taken orally, can also be effective in treating your symptoms by constricting the blood vessels in the nose and sinuses, but it can sometimes be harder to get at the drugstore. Medications like Sudafed contain pseudoephedrine, but you can only find it behind the pharmacy counter. The Sudafed you find over the counter, Sudafed PE, contains phenylephrine, the drug that’s been found not to work.
It’s important to note that the FDA says that nasal sprays with phenylephrine are still effective because they deliver the drug directly to the nasal passage where, like oxymetazoline and pseudoephedrine, it constricts blood vessels in the mucosa that lines the nose and sinuses.
Home remedies to treat nasal congestion
If you want to try a more natural route to treat your symptoms, you’re in luck — there are plenty of methods you can try before you reach for an over-the-counter drug.
Rizzo says that non-pharmacologic home remedies such as humidifiers and neti pots can help alleviate sinus congestion, especially if your symptoms are caused by allergens in your nasal passages.
For these methods, make sure to only use these devices with distilled, sterile or previously boiled water to decrease your risk of bacterial infection, as tap water can contain low levels of bacterial organisms.
If you don’t have a neti pot or a humidifier, a hot shower is another quick way to open up your nasal passages.
Wondering about topical methods? If your guardian loved to cover your neck and chest with a topical menthol-containing ointment when you had a stuffy nose, unfortunately, the efficacy of that method is based in myth.
“These topical ointments don’t work to alleviate congestion,” says Rizzo. "The strong fragrance only works to trick your brain into thinking that your breathing has improved.”
Other ways to help your sinuses
While you wait for one of these methods to take full effect, you might have another question: How do I breathe when my nose is so stopped up?
Rizzo says you can try a few things:
“Positional changes may help alleviate symptoms, such as utilizing pillows to elevate the head from a horizontal position while sleeping,” Rizzo says. “Sinus massages could also be considered to help with the pain and pressure associated with nasal congestion.”
In addition, make sure to drink plenty of water to keep your nasal passages moist and to encourage the thinning and drainage of mucus.
Finally, if your nasal congestion is coupled with high, persistent fevers or your symptoms don’t improve with any at-home or over-the-counter remedies after seven days, it’s time to see a doctor. Rizzo says this could indicate an unresolved bacterial sinus infection that may require antibiotic management.