Michael asked
Is it safe to take Sudafed long term? Does it cause rebound like other decongestants?
Answer
Sudafed (pseudoephedrine) is an oral decongestant, structurally similar to ephedrine. Unlike nasal decongestants, such as Afrin (oxymetazoline) and Neo-synephrine (phenylephrine), Sudafed has little to no risk of rebound congestion, a condition where nasal congestion worsens after the continuous use of a medication like Afrin.
So, if you are worried about long term use of Sudafed causing your nasal congestion to worsen, that won't happen for the vast majority of individuals. However, you need to consider the other effects Sudafed has on the body (e.g. increase in blood pressure) and there are some precautions to take.
Cardiovascular Effects Of Sudafed
The active ingredient in Sudafed, pseudoephedrine, can increase blood pressure due to its vasoconstrictive effects, and this must be considered for those who have high blood pressure or are taking medication for it. Just how risky this increase it varies by individual. Studies show that most individuals who have high blood pressure but are well controlled (either via lifestyle modifications or medication) taking pseudoephedrine at recommended doses do not appear at high risk for significant elevations in blood pressure. Nevertheless, significant increases in blood pressure (especially systolic) has been reported in some patients, who can be difficult to identify beforehand.
Other potential cardiovascular effects of Sudafed include:
- Angina
- Heart attack
- Palpitations
- Stroke
- Arrhythmias
The effects above effects generally occur only at excessive dosages or in individuals at a higher risk (e.g. prior heart attack history). Therefore, those with pre-existing heart disease or high blood pressure should check with their doctor prior to use since these conditions can be aggravated.
Alternatives To Sudafed
If you cannot take Sudafed, or you are worried about the long term cardiovascular effects, it may be a good idea to look into alternatives.
Antihistamines
If your nasal congestion is due to allergies, taking a daily antihistamine can provide good preventative relief. Typically, second and third generation antihistamines are the best options as they have a low incidence of drowsiness and can be dosed oince daily. They include:
- Claritin (loratadine)
- Allegra (fexofenadine)
- Zyrtec (cetirizine)
- Xyzal
Nasal Steroids
There are a variety of over the counter nasal steroids indicated for the treatment of nasal congestion and seasonal allergy symptoms. Daily use of these products can greatly reduce congestion and inflamed nasal passages, and for a longer duration of time than Sudafed. Over the counter nasal steroids include:
- Flonase
- Flonase Sensimist
- Nasacort
- Rhinocort
Saline Nasal Spray/Drops
Saline nasal spray, such as Ayr and Ocean, moisturize nasal passages and helps to clear the airways. Hypertonic saline nose sprays can be an effective treatment for nasal congestion. These products contain a higher concentration of saline, which helps to remove excess fluid for cells, decreasing inflammation and helping to reduce congestive symptoms.
Summary
- Sudafed is associated with little to no problems with rebound congestion, unlike topical nasal sprays like Afrin.
- Sudafed can cause increases in blood pressure and put certain individuals at risk for more serious cardiovascular complications.
