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New Warning That Popular Cold & Flu Medicines Could Trigger 'brain Swelling And Seizures'
PATIENTS must be warned of very rare life-threatening side effects associated with taking popular cold and flu meds, including Sudafed, officials have said.
Decongestants - which contain the ingredient pseudoephedrine - have been linked to two rare brain disorders.
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PRES and RCVS are rare but serious conditions which reduce blood supply to the brainCredit: GettyPatient information leaflets, found tucked inside medicine boxes, will be updated to "better describe" the rare risks, health chiefs said.
Doctors and pharmacists dishing out the over-the-counter (OTC) medicines must make sure patients buying these drugs are aware of the side effects.
The decision by the Medicines and Healthcare Products Regulatory Agency (MHRA) follows four reports of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) in people taking the medicines.
PRES and RCVS are extremely rare but serious conditions which reduce blood supply to the brain and can cause major and life-threatening complications, including seizures and swelling of the brain.
The drugs are already known to increase the risk of heart conditions and strokes, with restrictions and warnings already included in the medicines' product information.
Medicines with pseudoephedrine, taken orally, are used to treat nasal congestion resulting from a cold, flu or allergy and work by stimulating nerve endings to release noradrenaline, which causes the blood vessels to constrict.
Examples of pseudoephedrine-containing drugs include Sudafed, Galpseud, and Boots Decongestant.
It comes as codeine linctus, a syrup used to treat dry coughs in adults, was recently changed to a prescription-only medicine due to fears people could become addicted to it.
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The top 10 'superfoods' of 2024 to boost weight loss and ward off dementia Seek urgent medical adviceDr Alison Cave, at the MHRA, said: "Following a thorough review of new safety data, product information for all pseudoephedrine-containing medicines will be updated to better describe these very rare risks and the potential risk factors associated with these conditions.
"We remind healthcare professionals and patients that pseudoephedrine is for short-term use only and should only be used to relieve symptoms of nasal and sinus congestion in colds, flu, and allergies."
Dr Alison added that patients should "seek urgent medical advice" if they experience side effects, including "a severe headache that develops very quickly or you suddenly feel sick or are vomiting, confused or experiencing seizures or changes in vision".
"Please report any suspected side effects to our Yellow Card scheme," she said.
Michelle Riddalls, chief executive of PAGB, the trade association for manufacturers of over-the-counter medicines, said: "We are pleased that MHRA and its associated committees have thoroughly reviewed all the data available on pseudoephedrine and concluded that PRES and RCVS are extremely rare side effects.
"By ensuring that updates are made to the product information and widening healthcare professionals' ability to spot these very rare reactions means that these effective decongestants remain available in pharmacies in the UK."
What are the symptoms of PRES and RCVS?
Both PRES and RCVS are rare conditions that can lead to death if not treated.
PRES often causes headaches, vision problems, mental changes, seizures, and swelling in the brain, according to the NHS.
The symptoms of RCVS usually come on quickly and can be serious and life-threatening.
The severe "thunderclap" headache is the hallmark sign of RCVS and it may be the only symptom.
This headache often comes on abruptly, lasts for at least fine minutes and is often referred to as the 'worst headache of your life'.
Some people report a surge of high blood pressure and seizures when the headache comes on, experts at verywellhealth explain.
8 Best Nasal Decongestants
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Decongestants offer temporary relief from discomfort, but a common ingredient was found to be ineffective. Here's the lowdown and 8 products that do work.
If your nose is stuffed, your head is pounding, and you're having trouble breathing due to a cold, the flu, or allergies, you want relief fast. Nasal decongestants are designed to ease your symptoms and help you carry on with your day.
They're available over the counter (OTC) or behind the counter at relatively affordable prices. But that doesn't always make it easy to choose one that's right for you. For example, some stronger medications target multiple symptoms, while others simply relieve a stuffy nose caused by allergies. Some may make you drowsy, while others might make sleep difficult.
We've compiled a list of the best nasal decongestants for different goals and delivery methods to help you find what you need. But first, we explain what causes nasal congestion and how decongestant drugs work.
Although people often think nasal congestion is caused by excess mucus, it's actually a result of swollen blood vessels in the tissues of your nasal passages. This swelling blocks airflow and may also cause mucus buildup, both of which can create a feeling of fullness and pressure in your nasal cavities (also known as your sinuses).
Congestion can result from infection from colds, flus, and sinusitis; nasal polyps; or irritants in your environment. Some medications, such as sedatives and beta-blockers, can cause nasal congestion. Pregnancy may even be the underlying culprit.
There are several products that can temporarily relieve nasal congestion by reducing blood vessel swelling and tissue inflammation. This helps increase airflow and flush mucus and, in turn, relieves pressure in your sinuses.
If you have nasal congestion that doesn't clear up easily, talk with a healthcare professional. They can help you find out the cause and can recommend treatments to help.
Different decongestant drugs relieve nasal congestion in different ways. And some work better for some kinds of congestion than others.
It's also important to note that some decongestant medications, such as those that contain the drug pseudoephedrine, may not be recommended for use if you have health conditions such as high blood pressure and glaucoma.
Here's a basic overview of the drugs found in common OTC cold, flu, and allergy medications:
Pricing guide
Prices for medications that relieve nasal congestion vary based on a number of factors, including the amount of medication and the type of decongestant. For the products recommended in this article, the price range is about $6–$35.
Allegra Allergy is a once-a-day antihistamine that is used to relieve nasal congestion, sneezing, and a runny nose. Its active ingredient is fexofenadine HCI. We like the ease of this once-daily product, especially if you have allergies or sensitivities to multiple irritants, such as pollen and dust mites.
What to know: Allegra Allergy is not meant for children. You should not use it if you have kidney disease or if you use aluminum or magnesium antacids. Do not take it with fruit juice.
Best decongestant nasal spray Afrin No Drip Severe CongestionBecause nasal sprays like Afrin are directly applied to the nasal tissue, they work quickly to reduce inflammation there, providing fast relief.
Afrin's spray contains oxymetazoline hydrochloride and menthol, which relax and open your nasal passages pretty much right away, according to reviewers.
What to know: Afrin should be used only temporarily to relieve sinus congestion. Rebound stuffiness can occur in as little as 3 days. Using nasal sprays for a long time can lead to side effects.
Best nasal decongestant for kids Little Remedies Decongestant Nose DropsThese dye-free drops contain phenylephrine in a dosage that's safe for kids ages 2 years and up. The dropper-dose formula can be applied 2–3 drops at a time directly to nasal passages, which makes for fast relief (no waiting for oral medications to kick in at bedtime).
This decongestant can work for symptoms of a cold or flu, or it can be used to help manage congestion caused by allergies.
What to know: It can be difficult to get little ones to sit still to apply the drops. You may have better luck putting the formula in a spray-mist bottle or another mist-based bottle to help apply it to their noses.
Best decongestant for indoor/outdoor allergies Zyrtec AllergyZyrtec (cetirizine) is a second-generation antihistamine, which means it doesn't cross the blood-brain barrier. That's why it won't cause severe sedation or drowsiness.
Zyrtec is taken once a day to relieve nasal congestion and other allergy symptoms.
What to know: This medication provides 24-hour relief. Don't take more than the recommended dose. Don't drink alcohol or take sedatives while using Zyrtec. Children under 6 years old should not take Zyrtec. If you're over age 65 or have liver or kidney disease, talk with your doctor before using this product.
Best for colds and flu Sudafed Sinus Congestion 12-hourThis is a behind-the-counter medication, which means it's not kept in the aisle but rather behind a pharmacy or retail counter and can be purchased only with proof of age.
It contains pseudoephedrine, an effective decongestant that narrows blood vessels in your nasal passages to reduce swelling and relieve blockage. It can provide temporary relief for up to 12 hours.
It's important to note that this product is different from Sudafed PE, which is available on store shelves but contains phenylephrine and is therefore no longer recommended.
What to know: Sudafed is not recommended for children. It is also not recommended for adults who have high blood pressure, glaucoma, or diabetes or are pregnant.
Best decongestant on a budget NasalCrom Nasal Spray AllergyNasalCrom (cromolyn sodium) is a mast cell stabilizer used to prevent the release of histamine and other chemicals that can cause symptoms such as nasal congestion.
It is used to treat nasal congestion and inflammation caused by conditions such as bronchial asthma and allergies. We like that NasalCrom can be used to prevent sinus inflammation and congestion, as well as to treat it. We also like that it's steroid-free.
What to know: Cromolyn sodium is also used in products that treat eye allergies. However, NasalCrom is a nasal spray and should not be used in your eyes.
Best nasal decongestant for bedtime Mucinex NightshiftThis liquid formula contains acetaminophen for pain relief, dextromethorphan for cough suppression, and triprolidine, an antihistamine that reduces common cold symptoms such as watery eyes, sneezing, and a runny nose.
Triprolidine is a first-generation antihistamine that causes drowsiness, so make sure not to take Mucinex Nightshift during the day if you plan on being active.
It's great for bedtime because it calms coughing fits that may be keeping you up at night. Dextromethorphan is an antitussive. It works by reducing activity in the section of your brain that controls coughs.
What to know: Despite its name, this product doesn't contain ingredients that loosen mucus. Some reviewers note that they dislike the taste of this medication.
Best for congestion caused by pet allergies Flonase Allergy ReliefThe active ingredient in Flonase is fluticasone propionate, a type of corticosteroid known as a glucocorticoid. Flonase relieves nasal congestion by working with your immune system to reduce inflammation in your nasal passages.
It's effective at reducing allergic reactions caused by pet dander, dust, dust mites, and other allergens.
We like that you can use your HSA or FSA account to purchase Flonase. It's also available by prescription, which might mean you can get it from your doctor with insurance coverage.
What to know: Don't use Flonase if you take certain medications for HIV or for fungal infections. Children under 4 years old should not use this product. Don't combine Flonase with other steroids or use it to treat asthma.
* available behind the counter with proof of age or other requirements
When you're figuring out which decongestant to buy, you'll need to determine what's causing your congestion. If it's allergies, you'll probably want a product that contains an antihistamine ingredient such as diphenhydramine. Antihistamines target your body's immune response to allergens and irritants in the environment.
If you have cold or flu symptoms, you may be looking for a product that includes ingredients that constrict the blood vessels in your nose, such as phenylephrine or pseudoephedrine. As we mentioned, phenylephrine is considered safe and effective only when taken as a nasal spray, not as an oral tablet.
Some OTC sinus decongestant formulas include multiple ingredients for symptoms such as sinus congestion and headache. It's a good idea to check each ingredient separately for potential side effects and contraindications.
If you take other OTC drugs or supplements or prescription medications, make sure they're safe to use along with the decongestant you choose.
Keep in mind that taking too much pain medication can cause complications, including stomach issues, rebound headaches, and kidney damage.
Chronic allergies and nasal congestion caused by colds or the flu sometimes require prescription drugs or other treatments. If treating your congestion with OTC products isn't giving you enough relief, see your doctor. And always get medical care for symptoms such as:
In addition to using nasal decongestant drugs, there are home remedies that may help provide relief. At-home treatments for nasal congestion include:
That depends on the underlying cause of your congestion. If you have nasal congestion that's caused by allergies, an antihistamine may be your best bet. If you have significant stuffiness caused by a virus, consider using a decongestant.
That depends on the underlying cause of your congestion. If you have nasal congestion that's caused by allergies, an antihistamine may be your best bet. If you have significant stuffiness caused by a virus, consider using a decongestant.
What are the three types of decongestants?Decongestants are made up of two drugs: phenylephrine, which is effective only as a nasal spray/topical application, and pseudoephedrine, which is available as an oral medication and in spray/topical form.
The term "decongestants" sometimes also refers to other medications that help relieve nasal and sinus congestion, such as antihistamines and corticosteroids. Which are available as pills, liquids, and nasal sprays and drops.
Decongestants are made up of two drugs: phenylephrine, which is effective only as a nasal spray/topical application, and pseudoephedrine, which is available as an oral medication and in spray/topical form.
The term "decongestants" sometimes also refers to other medications that help relieve nasal and sinus congestion, such as antihistamines and corticosteroids. Which are available as pills, liquids, and nasal sprays and drops.
How do you unstuff your nose fast?Some people get the quickest results from combining fast-acting nasal sprays or oral medications with vapor rub. Vapor rubs use menthol and camphor to provide a temporary feeling of relief from nasal congestion, and they may help ease a cough and muscle pain.
Rubs should be applied to your chest and neck only — never use a vapor rub in or near your nose, as it can be absorbed through the mucous membrane lining and is potentially toxic.
Some people get the quickest results from combining fast-acting nasal sprays or oral medications with vapor rub. Vapor rubs use menthol and camphor to provide a temporary feeling of relief from nasal congestion, and they may help ease a cough and muscle pain.
Rubs should be applied to your chest and neck only — never use a vapor rub in or near your nose, as it can be absorbed through the mucous membrane lining and is potentially toxic.
The best way to choose a nasal decongestant is to look at the active ingredients. A good decongestant should treat only the symptoms you have, not any symptoms you don't have.
OTC decongestants are not a solution for severe, long lasting sinus infections and chronic allergies. You may need to talk with your doctor about a long-term strategy if you find that decongestants you buy in a store aren't effectively managing your symptoms.
Pharmacist Reveals The Surprising Over-the-counter Cold Drug That Gives You Insomnia
A pharmacist has warned people with colds and flu against taking a popular remedy before bed due to risks of insomnia.
In a clip shared with his 300,000 TikTok followers, Dr Ethan Melillo, a pharmacist from Rhode Island, said the decongestant pseudoephedrine can cause trouble sleeping.
This is because the ingredient can affect cells in the brain that are responsible for the jittery feeling associated with the 'fight or flight' phenomenon that keeps us safe when we're under threat.
Dr Melillo made the warning while holding up a packet of Sudafed - as pseudoephedrine is the main ingredient.
'Pseudoephedrine can cause insomnia,' he said. 'The best way to avoid insomnia is to try to take it at least two hours prior to bed.
'And at night I also recommend supplementing with a saline nasal spray.'
Saline nasal sprays are a well-proven decongestant which are known to cause few side effects as they do not contain any medicine.
Another popular decongestant came under fire last year after health chiefs at the FDA ruled it ineffective when it comes to treating nasal congestion.
Phenylephrine is found in drugs including Sudafed PE, Vicks Nyquil Sinex Nighttime Sinus Relief and Benadryl Allergy Plus Congestion.
Sudafed is known to cause insomnia due to the decongestant pseudoephedrine, which causes jitters
The drug is thought to relieve congestion by reducing the swelling of blood vessels in the nasal passages.
However, the expert panel reviewed a wealth of evidence and concluded that when taken orally, a very small amount of the drug actually reaches the nose to relieve congestion.
Following the ruling, in September last year, the nation's biggest pharmacies began to pull products from shelves, including CVS and Walgreens.
The ingredient is still considered safe by the FDA and is yet to be removed from the agency's list of ingredients for OTC use.
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