Nasal Decongestants

One of the physical effects of stimulants is to constrict blood vessels in the nose and sinuses. This constriction shrinks those tissues, allowing freer passage of air. The effect is temporary and, when the stimulant wears off, is usually followed by an opposite reaction, or "rebound/' in which the nasal passages become more blocked than before. This pattern is similar to the one that occurs with the bronchodilator drugs described above.

Early nasal inhalers contained strips of paper impregnated with amphetamine. Many users experienced general stimulation from them, some got high, and some became dependent. Some even broke open the containers and extracted the amphetamine in order to put it into their bodies in other ways. Eventually, manufacturers stopped using amphetamine in nasal inhalers, replacing it with other drugs supposed to be less stimulating and less addictive.

Today, the OTC inhalers and sprays sold to unblock stuffy noses are not considered psychoactive. Some of the inhalers contain no drugs but only aromatic substances such as menthol. They may be pleasant to use but are not nearly as effective as chemicals that constrict blood vessels. The sprays and those inhalers that do contain drugs certainly work in the short run, but though the manufacturers claim otherwise, they are still stimulants and frequently cause dependence.

Not everyone experiences general stimulation from these products, but those who do may come to use them habitually. Probably, a greater risk of dependence arises from the temporary nature of the relief they offer. If people continue to use them to treat the rebound that follows the initial dose, they quickly find themselves unable to breathe without them. Longer-acting preparations may be safer in this respect.

A few oral forms of decongestants are available: for example, pseudoephednne (Sudafed), a close relative of the natural stimulant ephedrine. Since it goes into the mouth rather than the nose, it is less likely to cause rebound and dependence, but for some people and in high doses it is definitely a stimulant. Our old friend phenylpropanolamine is often identified as an oral decongestant when it appears in OTC cold remedies and cough syrups; of course, it, too, is a stimulant.

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