Avoid These 5 Mistakes While Taking a Decongestant like Sudafed or Afrin
Key takeaways:
Pseudoephedrine (Sudafed), phenylephrine (Sudafed PE, Neo-Synephrine), and oxymetazoline (Afrin) are over-the-counter decongestants for a stuffy nose. While they’re convenient options, there are several mistakes you can make while taking them.
You may be tempted to take a decongestant longer than recommended on the label. If you need to take an oral decongestant longer than a week, you should see a healthcare professional. And using a nasal decongestant longer than 3 days can cause rebound (worsening) congestion.
Other common mistakes include taking decongestants before bed and mixing them with other stimulants or alcohol. Your pharmacist can be a helpful resource for how to effectively and safely take a decongestant.
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Table of contents
Whether it’s cold, flu, or allergy season, a stuffy nose can be an unwelcome surprise. Thankfully, there are over-the-counter (OTC) decongestants that can provide fast relief.
Oral options include pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE). Nasal sprays like oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine) are available, too.
But if you turn to these products to clear your sinuses, you should not only know how to take them, but also what to avoid. Below, we’ll discuss five common mistakes made while taking decongestants.
Good to know: In 2023, a group of FDA experts found that oral phenylephrine isn’t effective for nasal congestion based on what the science shows. These products aren’t harmful, but they may not work as well as other options for treating a stuffy nose. This doesn’t apply to phenylephrine nasal spray — it’s still considered an effective option.
1. Drinking alcohol while taking decongestants
It’s common to wonder if you can drink alcohol if you take phenylephrine or other decongestants. Drinking alcohol may be the last thing you want to do when you’re feeling sick. But for some people, a “hot toddy” may be a go-to cold and flu home remedy.
If you’re taking a decongestant, it’s best to avoid alcohol. The combination of pseudoephedrine and alcohol may worsen certain side effects, such as nausea, headache, and anxiety. That’s because alcohol can also cause these symptoms. This holds true for other oral or nasal decongestants, too.
Decongestants can also mask alcohol’s effects, so you may not be able to tell if you’re intoxicated. This could lead you to consume more alcohol than intended, which raises your risk of accidental harm.
What’s more, alcohol can weaken your immune system, making it harder to fight off an infection. So whether you’re taking decongestants or not, alcohol isn’t going to do you any favors when you’re sick.
Sudafed interactions: Learn which medications interact with Sudafed to help protect your health.
What’s the best cold and flu medication? Here’s how to choose an over-the-counter cold and flu treatment based on your symptoms.
Afrin vs. Sudafed: Read about the differences between oral and nasal decongestants to help you find the best product for your needs.
If allergies are the source of your stuffy nose, it’s still best to avoid alcohol. Histamines in certain types of alcohol may make your congestion worse.
It’s best to avoid alcohol while you’re taking a decongestant. If you’re planning to have a drink or two, it’s best to stop taking a decongestant until the following day. Talk to a healthcare professional for support if you’re unable to stop drinking — they can provide resources to help.
How long after taking phenylephrine (or other decongestants) can you drink alcohol?
It can take anywhere from 15 to 80 hours for your body to clear pseudoephedrine after your last dose. So it’s best to wait at least a full day after taking it before drinking alcohol. Phenylephrine is typically cleared in about 15 hours, but it’s still a good idea to wait until the next day to have a drink to be safe.
2. Taking decongestants longer than recommended
There are several risks of taking decongestants longer than you should. And specific risks can depend on which type of decongestant you’re taking. These risks include:
Rebound congestion. Nasal decongestants such as Afrin can cause rebound congestion if you use them too long. This can worsen your congestion or make it more difficult to treat. Only use decongestant nasal sprays for up to 3 days in a row to minimize this risk.
Changes in blood pressure and heart rate. Oral decongestants aren’t known to cause rebound congestion, but they have other risks. This includes increased blood pressure and heart rate, which is especially risky if you have heart problems already. And the chance of these risks is greater the longer you take an oral decongestant.
Dependence and misuse. Pseudoephedrie can be habit forming, resulting in cravings and withdrawal symptoms if it’s misused. Historically, it’s been used to make illegal stimulants. Because of this, products that contain pseudoephedrine are kept behind the pharmacy counter, and some states require a prescription. Plus, there are daily and monthly limits on how much you can purchase.
How long should you take oral decongestants?
Oral decongestants are meant to be taken short term. But what if you need them longer than what it says on the OTC medicine label?
For cold and flu symptoms: If you’re self-treating cold and flu symptoms with an oral decongestant, you should only take it for up to 7 days. Talk to a healthcare professional if congestion doesn’t improve after 7 days, you develop a fever, or your symptoms are getting worse.
For allergies: Short-term use (up to 7 days) of oral decongestants may be helpful for congestion due to allergies. But if you need a long-term treatment to last through allergy season, steroid nasal sprays, such as Flonase (fluticasone), are a better option.
3. Taking decongestants before you go to bed
Have you ever noticed that oral decongestants are often found in “daytime” cold and flu products, but not “nighttime” versions? This is for a good reason. Decongestants have stimulating effects on your brain, which can make it harder to fall asleep if you take them at night.
To get a better night’s sleep, avoid taking a decongestant after 6 PM or within a few hours of when you usually go to bed.
Keep in mind: Pseudoephedrine is available in both immediate-release (IR) and extended-release (ER) dosage forms. The effects of ER forms can last up to 12 to 24 hours, depending on the product you’re taking. If you’re having sleeping problems with a longer-acting version, it may help to take a shorter-acting product instead.
4. Doubling up on decongestants
In the case of decongestants, more isn’t better. For example, you shouldn’t take pseudoephedrine and use Afrin nasal spray at the same time. The combination won’t work any better, and you’ll have a higher risk of side effects, such headache, restlessness, and nausea. You also shouldn’t take a higher dosage of a decongestant than recommended for the same reason.
Decongestants are also often hidden in multi-symptom cold and flu products, such as Theraflu. So it’s important to read the label closely to ensure you’re not doubling up on ingredients. For people age 12 and older, the maximum amount of pseudoephedrine is 240 mg in 24 hours. For phenylephrine, it’s typically 60 mg in 24 hours. These amounts are lower for children under age 12.
It’s also possible to overdose on decongestants. Signs you’ve taken too much include a fast or irregular heartbeat, difficulty breathing, and dizziness. Contact a healthcare professional right away if these develop. If any symptoms seem severe or life-threatening, call 911 or go to your nearest ER.
If you’re unsure which OTC products contain decongestants, check with your pharmacist. They can also help you figure out how much you’re taking to ensure it’s a safe amount.
5. Combining decongestants with other stimulants
As mentioned above, decongestants have stimulating effects. And when you combine them with other stimulants, these effects can be amplified. This combination can also be dangerous, resulting in irregular heartbeats and very high blood pressure. Because of this, older adults and people with heart conditions should use additional caution.
There are a few different types of stimulants. They include prescription medications, such as amphetamine salts (Adderall) and phentermine (Adipex-P). Caffeine is also a stimulant that’s found in many drinks, foods, and OTC products.
If you’re taking or consuming any stimulants, check with your healthcare team before starting a decongestant. They can let you know if the combination is OK, or recommend safer alternatives.
Frequently asked questions
Probably. Decongestants aren’t likely to interact with most antibiotics. So it’s fine to take them together in most cases. The one exception to this is the antibiotic linezolid (Zyvox). It can cause very high blood pressure if you take it along with a decongestant, so it’s best to avoid this combination.
Oral and nasal decongestants aren’t recommended if you’re pregnant. Studies are mixed, but since there may be a link between decongestants and birth defects, it’s best to err on the side of caution. If your symptoms are severe, your OB/GYN may OK taking a decongestant for a day or so. But this can vary depending on how far along you are, and you shouldn’t use them without a healthcare professional’s approval.
The bottom line
Decongestants, such as pseudoephedrine (Sudafed) and oxymetazoline (Afrin), can come in handy to relieve a stuffy nose. But there are several do’s and don’ts to follow when taking them. You shouldn’t drink alcohol or take other stimulants while taking a decongestant. Taking it at night and doubling up on decongestants should be avoided, too.
Don’t take pseudoephedrine or other oral decongestants for longer than 7 days without a healthcare professional’s OK. And avoid using Afrin or other decongestant nasal sprays for more than 3 days in a row. A good place to start is by following the directions on the decongestant label. Your pharmacist is also a helpful resource for tips on taking decongestants safely.
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References
Deng, Y., et al. (2021). Effects of acute alcohol intake on nasal patency. American Journal of Rhinology & Allergy.
Farzam, K., et al. (2023). Stimulants. StatPearls.
Głowacka, K., et al. (2021). Pseudoephedrine—benefits and risks. International Journal of Molecular Sciences.
Hilty, D., et al. (2009). Algorithms for the assessment and management of insomnia in primary care. Patient Preference and Adherence.
MedlinePlus. (2018). Pseudoephedrine.
National Institute on Drug Abuse. (2016). Is it safe to use prescription drugs in combination with other medications?
Richards, E., et al. (2023). Phenlynephrine. StatPearls.
U.S. Food and Drug Administration. (2023). FDA clarifies results of recent advisory committee meeting on oral phenylephrine.
