My Quora Answer: Nasal Congestion Relief

I promise I will post my "Adult Upper Respiratory Infection Recommendations" for you soon. It may now be too late for this Cold season but it is amazing advice.

By “clogged” you mean “congestion” which is caused by edema and swelling of your nasal mucous membranes. Many people believe that congestion is due to nasal discharge but that is only partly true as snot may build up behind a congested passage. Therefore, the best medications contain a decongestant. Mucolytics, or chemicals that cause thinning of the discharge help a little bit, mainly by helping liquid snot to sneak past your inflamed mucous membranes. The most common one is Mucinex, mainly because of clever and frequent commercials. Its active ingredient is guaifenesin which is also found in a myriad of other products such as Robitussin.

As an aside, the “DM” in Robitussin-DM stands for dextromethorphan, a highly effective cough suppressant. Because it is derived from opiates, it is often abused by narcotic addicts. They have to drink several bottles to even get a little buzzed. My guess is that they abuse it in order to get out of or prevent withdrawal until they can score the real stuff. I cannot imagine drinking even one bottle of it, much less several.

And now, back to congestion and decongestants. These appear in several forms, including orally and topically. The latter means they are applied directly to the nasal mucous membranes, either via a spray, mist, or gel. They work by constricting the small blood vessels (arterioles) in your nose, which lessens and prevents fluid drainage. In the U.S., these include phenylephrine (which is the “PE” in their names), desoxyephedrine found in Vicks Vapo inhaler, and oxymetazoline, the active ingredient in Afrin. The FDA banned ephedrine, a very good one because people use it to create amphetamines. It is still available worldwide.

My favorite decongestant is oxymetazoline because it is very effective and is active for 12 hours. When it first came out, it cost me $12 per 3 oz bottle. Now that it has gone generic, I pay $1.00 for 1 oz at Family Dollar. Same chemical, way better price. It is also one of the medications that I recommend in my “Adult Upper Respiratory Infection” pamphlet. When I get the chance, or really when I am asked, I will post the whole thing here on Quora for you.
The biggest hazard of using Afrin is that you can become addicted to it. This isn’t what we usually think of that word, but rather that you need to keep using it in order to breathe. It has a rebound effect too, meaning that the congestion is worse when it wears off. To prevent this, I use it alternating nostrils because hey, you only need one open in order to breathe through it. Even if it becomes more edematous, you are giving it a 24-hour rest to return to baseline.

Since several symptoms appear early in the course of a URI which are mediated by the release of histamine, antihistamines such as diphenhydramine (Benadryl), work wonders. But only in the first 3 days. After that, histamine release lessens and using an antihistamine is worthless, if not outright negative. The main side-effect is dryness and you don’t want that. The early fluid discharge is so significant that this shouldn't occur.

One final recommendation and it’s a good one. Nasal congestion is also caused by inflammation. Therefore, the Non-Steroidal Noninflammatory Drugs (NSAID’s) work wonders throughout the course of the illness. They are also pain meds and antipyretics (bring down fevers). These include ibuprofen, naproxen (Aleve), and even aspirin. I prefer naproxen since dosing is only once-a-day and doesn’t upset my stomach like ibuprofen. Even better, is that there is Aleve-D, which contains a decongestant.

When naproxen was available only by prescription, we often wrote prescriptions for up to 750 mg BID (twice a day). The usual for an adult was 500 mg BID. However, when it went over-the-counter (OTC), the pharmaceutical company cut the dose to only 220 mg every 8 hours. I facetiously call this a “homeopathic dose.” So for really amazing relief, I recommend one regular Aleve tablet or capsule plus one Aleve-D 2–3 times per day. Once again, take with food and avoid if you have a history of asthma, peptic ulcers, or kidney disease, or are allergic to any NSAID.