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What medication should be taken for cold and clogged nose

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"common cold"[MeSH Terms] AND "nasal decongestants"[MeSH Terms]

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common cold nasal congestion treatment oral decongestant pseudoephedrine phenylephrine FDA advisory

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For a cold with a blocked nose, the usual choices are a nasal decongestant (spray or tablet), saline rinses, and a pain or fever reliever if you need one. These treat symptoms only. The cold is viral and will clear on its own, usually in about a week.
1. Decongestant nasal spray (works fastest and best)
  • Oxymetazoline and xylometazoline sprays act within minutes and are usually more effective than tablets. Cummings Otolaryngology lists these as the main topical options.
  • Use them for no more than 3 days. Longer use causes rebound swelling (rhinitis medicamentosa). This limit is in both the Cummings and Textbook of Family Medicine 9e (Rhinitis section, p. 419) sections.
2. Saline nasal spray or irrigation
  • It thins and washes out thick mucus. It is safe to use as often as you like, including in children and in pregnancy.
3. Oral decongestant tablets
  • Pseudoephedrine works for congestion. In the US you ask for it at the pharmacy counter. Tablets don't cause rebound congestion but are weaker than sprays. Common side effects are insomnia, irritability, a fast heartbeat and raised blood pressure (Cummings Otolaryngology, Decongestants section).
  • Oral phenylephrine probably doesn't work. A 2007 meta-analysis found no benefit over placebo. In 2023 an FDA advisory panel unanimously agreed, and the FDA has since proposed removing it as an OTC decongestant. Many "PE" cold products fall into this group, so check the label.
4. Combination cold products
  • Antihistamine plus decongestant plus pain reliever combinations give "some general benefit" in adults and older children (Textbook of Family Medicine 9e, p. 419, citing Cochrane).
  • Older sedating antihistamines (chlorpheniramine, diphenhydramine) help with sneezing and a runny nose but cause drowsiness in about 20% of people. Newer ones such as loratadine and cetirizine are less sedating, though they help colds less than allergies.
5. Other options
  • Paracetamol (acetaminophen) or ibuprofen for headache, body aches and fever.
  • Intranasal ipratropium helps a runny nose but does little for congestion.
  • Zinc lozenges started within 24 hours of symptoms may shorten a cold, but the evidence is mixed and they can cause nausea.
  • Steam, fluids and rest are reasonable comfort measures.
Who should avoid decongestants
  • People with high blood pressure, heart disease, an irregular heartbeat, an overactive thyroid, glaucoma, or an enlarged prostate with urinary retention should avoid them. Ask a doctor or pharmacist first.
  • Pregnant women should check with a doctor first. Saline and a short course of spray are the usual safer choices.
  • Children under 6 should not be given OTC cold and decongestant products. Use saline drops and suction, and check with a doctor for any infant. The library's family medicine review notes that decongestants and antihistamines in infants can cause unusual central nervous system or cardiovascular effects.
Antibiotics don't help a cold. See a doctor if you have any of these:
  • Symptoms lasting more than 10 days, or getting worse after initial improvement.
  • A high fever.
  • Severe facial pain.
  • Shortness of breath.
  • Ear pain.
The recent PubMed systematic reviews I searched turned up nothing that changes these recommendations.
I can adjust this if you tell me your age, whether you're pregnant, or what other conditions or medicines you have.
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