Every day in my family medicine clinic, at least one patient is sick with common cold symptoms like rhinorrhea, otherwise known as runny nose and sinus congestion. The question is the same: what’s the best treatment for a runny nose? I’m sharing this because most of my patients are not taking what I think is most effective.

They’ll be on stuff like Dayquil and Mucosolvan, which I generally find very ineffective. And they want antibiotics because they’re not getting better on their OTC meds. So… first I go through the inevitable conversation about how the majority of the time, they suffer from a virus and not a bacteria, and thus their expected Z-pack or amoxicillin won’t help. Then, assuming they haven’t hung up on me, I go over the much better OTC decongestion meds which will greatly help their symptoms.

I have two favorites that I want to share with you: Sudafed (specifically pseudoephedrine) and Afrin, which is the brand name for oxymetazoline nasal spray. But first, I need to clarify something very important about Sudafed. There’s a product on the shelf called Sudafed PE, and I have to tell you—this one doesn’t work! Sudafed PE contains the chemical phenylephrine, which the FDA recently stated, after reviewing studies, does not provide relief when compared to a placebo. It’s so ineffective that they recommended pulling it from all pharmacy shelves in 2023. Unfortunately, most pharmacies still sell it. All of the combination medicines that have the PE in the title do not help with runny nose.

If you want the real deal, you need to ask your pharmacist for the original Sudafed: pseudoephedrine. This is the “PSE” on the label. Don’t worry about the pharmacy regulation, any adult can buy it — it’s not a prescription, but you will have to sign for it. (It’s regulated by US law because people used to buy cases of it to cook in meth labs.) This is important information that a lot of people still don’t know! This original version is much more effective. See the comparison data:

Afrin

Now, let’s talk about Afrin. Oxymetazoline works wonders! It typically starts working within 10 minutes and can provide relief for up to 10 hours. However, there’s a catch: it’s best used for no longer than five consecutive days.

Why? Because of something called “Afrin addiction” to normal people, and “Rhinitis Medicamentosa” to doctors. Yes, it’s a real issue! Some people find themselves dependent on Afrin, using it for years. The problem is that once it wears off, they experience rebound congestion—meaning their nose feels even stuffier without it. So, use Afrin as needed, but don’t let it become a long-term crutch. Read here for advice from the Cleveland Clinic on how to break this habit.

But as long as you stick to that 5-day-ish limit, twice a day for a couple of days every few months for nasal congestion is perfectly fine. I highly recommend you keep a bottle at home.

Prescription ipratropium

In addition to these over-the-counter options, I’ve been prescribing a medication called Ipratropium —a nasal spray that can work effectively for chronic or temporary runny noses due to congestion. If you’re really struggling, it’s worth asking your doctor about it.

So, there you have it! Sudafed (pseudoephedrine) and Afrin (oxymetazoline) can be effective treatments for your runny nose, but use them wisely. Remember, always consult with your healthcare provider for the best advice tailored to your situation.

More Information

Check out my video on Sudafed vs Afrin below; also articles about 6 Herbals To Help the Common Cold