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{{short description|Drug to relieve nasal congestion}} |
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{{Unreferenced|date=July 2009}} |
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{{About|decongestant medications|their nasal delivery system|inhaler}} |
{{About|decongestant medications|their nasal delivery system|inhaler}} |
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A '''decongestant''', or '''nasal decongestant''', is a type of [[pharmaceutical drug]] that is used to relieve [[nasal congestion]] in the [[upper respiratory tract]]. The active ingredient in most decongestants is either [[pseudoephedrine]] or [[phenylephrine]] (the latter of which has [[Phenylephrine#Decongestant|disputed |
A '''decongestant''', or '''nasal decongestant''', is a type of [[pharmaceutical drug]] that is used to relieve [[nasal congestion]] in the [[upper respiratory tract]]. The active ingredient in most decongestants is either [[pseudoephedrine]] or [[phenylephrine]] (the latter of which has [[Phenylephrine#Decongestant|disputed effectiveness]]). Intranasal [[corticosteroid]]s can also be used as decongestants and [[antihistamine]]s can be used to alleviate [[runny nose]], [[rhinitis|nasal itch]], and [[sneeze|sneezing]].<ref name="Ficalora2013">{{cite book|author=Robert D. Ficalora|title=Mayo Clinic Internal Medicine Board Review|url=https://books.google.com/books?id=UH5pAgAAQBAJ&pg=PA579|date=28 May 2013|publisher=Oxford University Press|isbn=978-0-19-998589-0|pages=579–}}</ref> |
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[[Topical decongestant]]s on [[topical administration|topical application]] as dilute solution (0.05–0.1%) produce local [[vasoconstriction]]. |
[[Topical decongestant]]s on [[topical administration|topical application]] as dilute solution (0.05–0.1%) produce local [[vasoconstriction]]. |
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Regular use of decongestants for long periods should be avoided because mucosal ciliary function is impaired: atrophic rhinitis and [[anosmia]] can occur due to persistent vasoconstriction. |
Regular use of decongestants for long periods should be avoided because mucosal ciliary function is impaired: atrophic rhinitis and [[anosmia]] (loss of the sense of smell) can occur due to persistent vasoconstriction. |
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Decongestants can be absorbed from the nose via an [[inhaler]] and produce systemic effects, mainly [[central nervous system]] stimulation and rise in [[blood pressure]]. These drugs should be used cautiously in hypertensives and in those receiving [[ |
Decongestants can be absorbed from the nose via an [[inhaler]] and produce systemic effects, mainly [[central nervous system]] stimulation and rise in [[blood pressure]]. These drugs should be used cautiously in hypertensives and in those receiving [[monoamine oxidase inhibitor]]s (MAOIs), as they can cause [[hypertensive crisis]]. |
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[[Expectorant]]s such as [[guaifenesin]] are a related type of drug which help to clear [[mucus]]. |
[[Expectorant]]s such as [[guaifenesin]] are a related type of drug which help to clear [[mucus]]. |
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{{TOC limit|3}} |
{{TOC limit|3}} |
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==Medical uses== |
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Decongestants are used to treat [[nasal congestion]], for instance in [[allergy|allergies]], [[infection]]s like the [[common cold]], [[influenza]], and [[sinusitis|sinus infection]], and [[nasal polyp]]s. Decongestants are also used to reduce redness in the treatment of simple conjunctivitis. |
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A 2016 [[Cochrane (organisation)|Cochrane]] [[systematic review|review]] found insufficient evidence to support the use of intranasal corticosteroids in the relief of common cold symptoms;<ref name="pmid26461493">{{cite journal | vauthors = Hayward G, Thompson MJ, Perera R, Del Mar CB, Glasziou PP, Heneghan CJ | title = Corticosteroids for the common cold | journal = Cochrane Database Syst Rev | issue = 10 | pages = CD008116 | year = 2015 | pmid = 26461493 | doi = 10.1002/14651858.CD008116.pub3 | url =https://pure.bond.edu.au/ws/files/32879677/Corticosteroids_for_the_common_cold.pdf }}</ref> however, the review was based on three trials and the quality of the evidence was regarded as very low.<ref name="pmid26461493" /> |
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==Pharmacology== |
==Pharmacology== |
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The vast majority of decongestants act via enhancing [[norepinephrine]] (noradrenaline) and [[epinephrine]] (adrenaline) or [[adrenergic]] activity by stimulating the [[adrenergic receptor| |
The vast majority of decongestants act via enhancing [[norepinephrine]] (noradrenaline) and [[epinephrine]] (adrenaline) or [[adrenergic]] activity by stimulating the [[adrenergic receptor|α1-adrenergic receptor ]] since they mediate vasoconstriction and constricting nasal vasculature causes decongestion of nasal mucosa. This induces [[vasoconstriction]] of the [[blood vessel]]s in the [[human nose|nose]], [[throat]], and [[paranasal sinuses]], which results in reduced [[inflammation]] ([[swelling (medical)|swelling]]) and [[mucus]] formation in these areas. |
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Decongestant nasal sprays and eye drops often contain [[oxymetazoline]] and are used for [[topical decongestant|topical decongestion]]. Pseudoephedrine acts indirectly on the adrenergic receptor system, whereas phenylephrine and oxymetazoline are direct [[agonists]]. The effects are not limited to the nose, and these medicines may cause [[hypertension]] (high blood pressure) through [[vasoconstriction]]; it is for this reason that people with hypertension are advised to avoid them. Most decongestants, however, are not pronounced stimulants, due to lack of response from the other adrenoreceptors. Besides hypertension, common side-effects include sleeplessness, anxiety, dizziness, excitability, and nervousness. |
Decongestant nasal sprays and eye drops often contain [[oxymetazoline]] and are used for [[topical decongestant|topical decongestion]]. Pseudoephedrine acts indirectly on the adrenergic receptor system, whereas phenylephrine and oxymetazoline are direct [[agonists]]. The effects are not limited to the nose, and these medicines may cause [[hypertension]] (high blood pressure) through [[vasoconstriction]]; it is for this reason that people with hypertension are advised to avoid them. Most decongestants, however, are not pronounced stimulants, due to lack of response from the other adrenoreceptors. Besides hypertension, common side-effects include sleeplessness, anxiety, dizziness, excitability, and nervousness. |
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Topical nasal or ophthalmic decongestants quickly develop [[tachyphylaxis]] (''a rapid decrease in the response to a drug after repeated doses over a short period of time''). Long-term use is not recommended |
Topical nasal or ophthalmic decongestants quickly develop [[tachyphylaxis]] (''a rapid decrease in the response to a drug after repeated doses over a short period of time''). Long-term use is not recommended since these agents lose effectiveness after a few days. |
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==List of |
==List of agents== |
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===Adrenaline releasing agents=== |
===Adrenaline releasing agents=== |
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====Uncommon or discontinued==== |
====Uncommon or discontinued==== |
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* [[Amphetamine]] (formerly sold as [[Benzedrine]], now a controlled substance in most jurisdictions) |
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* [[Cyclopentamine]] |
* [[Cyclopentamine]] |
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* [[Mephentermine]] |
* [[Mephentermine]] |
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* [[Norepinephrine|Norepinephrine (noradrenaline)]] |
* [[Norepinephrine|Norepinephrine (noradrenaline)]] |
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* [[Tymazoline]] |
* [[Tymazoline]] |
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===Corticosteroids=== |
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* [[Beclomethasone dipropionate]] (Beconase, QNASL) |
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* [[Budesonide]] (Rhinocort) |
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* [[Ciclesonide]] (Omnaris, Zetonna) |
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* [[Dexamethasone]] |
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* [[Flunisolide]] (Nasarel) |
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* [[Fluticasone]] |
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* [[Fluticasone furoate]] (Veramyst) |
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* [[Fluticasone propionate]] (Flonase) |
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** [[Azelastine/fluticasone]] (Dymista) – also an [[antihistamine]] via [[azelastine]] |
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* [[Mometasone furoate]] (Nasonex) |
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* [[Prednisolone]] |
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* [[Tixocortol]] (Pivalone) |
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* [[Triamcinolone]] (Nasacort) |
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* [[Triamcinolone acetonide]] (Nasacort, Allernaze) |
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===Miscellaneous=== |
===Miscellaneous=== |
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====Common or widely marketed==== |
====Common or widely marketed==== |
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* [[Nasal spray#Saline |
* [[Nasal spray#Saline|Saline]] ([[saline (medicine)|water and sodium chloride solution]]) |
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====Uncommon or discontinued==== |
====Uncommon or discontinued==== |
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[[Category:Decongestants|*]] |
[[Category:Decongestants|*]] |
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[[Category:Rhinology]] |
Adecongestant, or nasal decongestant, is a type of pharmaceutical drug that is used to relieve nasal congestion in the upper respiratory tract. The active ingredient in most decongestants is either pseudoephedrineorphenylephrine (the latter of which has disputed effectiveness). Intranasal corticosteroids can also be used as decongestants and antihistamines can be used to alleviate runny nose, nasal itch, and sneezing.[1]
Topical decongestantsontopical application as dilute solution (0.05–0.1%) produce local vasoconstriction.
Regular use of decongestants for long periods should be avoided because mucosal ciliary function is impaired: atrophic rhinitis and anosmia (loss of the sense of smell) can occur due to persistent vasoconstriction.
Decongestants can be absorbed from the nose via an inhaler and produce systemic effects, mainly central nervous system stimulation and rise in blood pressure. These drugs should be used cautiously in hypertensives and in those receiving monoamine oxidase inhibitors (MAOIs), as they can cause hypertensive crisis.
Expectorants such as guaifenesin are a related type of drug which help to clear mucus.
Decongestants are used to treat nasal congestion, for instance in allergies, infections like the common cold, influenza, and sinus infection, and nasal polyps. Decongestants are also used to reduce redness in the treatment of simple conjunctivitis.
A 2016 Cochrane review found insufficient evidence to support the use of intranasal corticosteroids in the relief of common cold symptoms;[2] however, the review was based on three trials and the quality of the evidence was regarded as very low.[2]
The vast majority of decongestants act via enhancing norepinephrine (noradrenaline) and epinephrine (adrenaline) or adrenergic activity by stimulating the α1-adrenergic receptor since they mediate vasoconstriction and constricting nasal vasculature causes decongestion of nasal mucosa. This induces vasoconstriction of the blood vessels in the nose, throat, and paranasal sinuses, which results in reduced inflammation (swelling) and mucus formation in these areas.
Decongestant nasal sprays and eye drops often contain oxymetazoline and are used for topical decongestion. Pseudoephedrine acts indirectly on the adrenergic receptor system, whereas phenylephrine and oxymetazoline are direct agonists. The effects are not limited to the nose, and these medicines may cause hypertension (high blood pressure) through vasoconstriction; it is for this reason that people with hypertension are advised to avoid them. Most decongestants, however, are not pronounced stimulants, due to lack of response from the other adrenoreceptors. Besides hypertension, common side-effects include sleeplessness, anxiety, dizziness, excitability, and nervousness.
Topical nasal or ophthalmic decongestants quickly develop tachyphylaxis (a rapid decrease in the response to a drug after repeated doses over a short period of time). Long-term use is not recommended since these agents lose effectiveness after a few days.
Major chemical drug groups – based upon the Anatomical Therapeutic Chemical Classification System
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gastrointestinal tract / metabolism (A) |
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blood and blood forming organs (B) |
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cardiovascular system (C) |
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skin (D) |
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genitourinary system (G) |
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endocrine system (H) |
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infections and infestations (J, P, QI) |
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malignant disease (L01–L02) |
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immune disease (L03–L04) |
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muscles, bones, and joints (M) |
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brain and nervous system (N) |
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respiratory system (R) |
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sensory organs (S) |
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other ATC (V) |
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Decongestants and other nasal preparations (R01)
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Topical |
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Systemic use: Sympathomimetics |
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