Table of ContentsView AllTable of ContentsUnderstanding Sinus InfectionsDecongestantsAntihistaminesTips for ReliefInteractionsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Understanding Sinus Infections
Decongestants
Antihistamines
Tips for Relief
Interactions
Frequently Asked Questions
Sinusitisaffects around 1 in 8 adults in the United States. Infection is a frequent cause of sinusitis, affecting about 29 million Americans yearly.
Antibioticsmay not be necessary unless the sinus infection is severe and leads to a bacterial infection. Instead, guidelines recommend management strategies aiming to ease symptoms.
Over-the-counter (OTC) medications often help ease sinus-related symptoms, such as pain relievers for sinus headaches andantihistaminesforrunny noseor postnasal drip.
These and other OTC medications may be used alone or in varying combinations for maximal symptom relief.
You can consult a pharmacist or healthcare provider for help finding the proper medications to ease your symptoms.
Read on for a more in-depth look at sinusitis, its causes, treatments, and how to manage sinus-related symptoms.
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The sinuses are small air pockets behind your nose, cheeks, eyes, and forehead. When the lining of the sinuses becomes swollen, it’s called sinusitis.
With asinus infection, germs (bacterial, viral, or fungal microorganisms) enter and spread within your sinus cavity.
Your immune system launches an attack against the infection, releasing immune cells and triggering inflammation.
This leads to symptoms that can range from pesky to downright miserable.
Symptoms
Common symptoms of sinus infections include facial pain, congestion, headache, and postnasal drip.
Other symptoms are fever, runny nose, itchy throat, sore throat, cough, and excess mucus.
You might only need antibiotics if your sinus infection persists for longer than a week or becomes more severe. As such, watchful waiting is often the best approach for mild cases in adults.
Most people improve naturally, with antibiotics only slightly increasing symptom relief.
Commonly Used OTC Medications
OTC medicines include:
These medicines, aimed at treating symptoms, and self-care methods like rest may allow you to cope with a sinus infection without a healthcare provider visit or prescription.
Healthcare providers may prescribe antibiotics, such asAugmentin (amoxicillin/clavulanic acid), or other antimicrobials in more severe sinus infections that persist for more than one or two weeks.
This article will discuss some of the best OTC medicines for sinus infections.
There are two main decongestants: topical (nasal sprays or drops) and oral (tablets or capsules you swallow).
Topical decongestants, such asAfrin (oxymetazoline nasal spray), offer quick relief from sinus discomfort, and make it easier to breathe through your nose.
You should use decongestants for no longer than three to five days. Exceeding this limit can lead to rebound congestion and make congestion worse instead of better.
Due to dosage differences among various brands, follow the dosing instructions and age limits on the label for your specific product. A common side effect is temporary stinging or burning sensations in the nose.
What Is Sudafed?
Sudafed (pseudoephedrine, or PSE) is the most commonly recommended oral decongestant. PSE helps unblock your nasal passages and sinuses, making breathing easier.
It can also reduce the amount of mucus in your nose and help the Eustachian tube (a part of your ear) stay open.
In terms of side effects, PSE stimulates the body’sfight-or-flight response, leading to:
Due to these effects, decongestants should only be used in the short term, and some people should refrain from using them.
Consult a healthcare professional before using a decongestant if you have:
In addition, PSE is not recommended for children younger than 2 years old, and the extended-release (ER) formulation is not recommended for those younger than 12 years old.
In fall 2023, a panel of experts at the Food and Drug Administration (FDA) issued a report that the oral decongestant ingredient phenylephrineisn’t effective.
Phenylephrine is the active ingredient in Sudafed PE and many other OTC cold medicines, such asDayQuil. However, generations of pharmacists have recommended pseudoephedrine over phenylephrine for those who were cleared to take it.
When you select an oral decongestant, please look for products containing pseudoephedrine (sold at your pharmacy counter and unavailable on store shelves) instead of phenylephrine.
Phenylephrine is also an ingredient in topical decongestant nasal sprays, but the FDA’s discussion and recommendations pertain only to oral forms of phenylephrine—not the nasal spray.
Antihistaminesare the go-to medications for the “runny or itchy” symptoms: sneezing, runny nose, postnasal drip, itchy throat, and watery eyes. Some or all of these symptoms can accompany sinus infections.
This prevents histamine from binding to cells throughout the body, including those in the eyes and nasal passages. By blocking histamine, antihistamines reduce the severity and frequency of symptoms like sneezing and runny nose.
Types of Antihistamines
Oral formulations of antihistamines include tablets, capsules, chewable tablets, and liquids.
Remember that the FDA doesn’t specifically approve antihistamines for sinus infections. However, healthcare professionals often recommend them to relieve symptoms of colds and sinusitis.
The following main groups of antihistamines are available without a prescription:
For context, Benadryl is FDA-approved for use in children 6 years and older.
Claritin and Zyrtec are approved for use in children 2 years and older.
Claritin and Zyrtec are similarly effective. However, it’s important to note that individual responses to these medications can differ, and what works better for one person might not for another.
Studies suggest that second-generation antihistamines are safer for children than first-generation, with cetirizine being more likely to cause drowsiness than the other newer-generation antihistamines.
To ensure proper use of antihistamines, follow the recommended dosage and age guidelines on the medication label or personalized instructions from a healthcare provider.
Tips for Sinus Infection Relief
Try to follow preventive measures to help reduce the risk of sinus infections and promote sinus health, such as:
Potential for Interaction
OTC sinus relief medications can interact with various prescription medications, potentially leading to harmful effects.
While not an all-inclusive list, here are five key examples of prescription medications that can interact with OTC sinus medications:
Blood Pressure and Heart Medications
Nasal decongestants, like pseudoephedrine, can raise blood pressure.
Combining blood pressure medications for high blood pressure or other heart conditions with cold or allergy medications can raise your blood pressure and lower the effectiveness of antihypertensive medications.
Examples includebeta-blockermedications, such asToprol XL (metoprolol), orcalcium channel blockers, such asNorvasc (amlodipine).
Antidepressants
Cold and sinus medications, especially those containing the decongestant pseudoephedrine, can increase blood pressure and heart rate.
When taken with antidepressants commonly used to treat depression and anxiety, there is an increased risk of worsening these cardiovascular effects.
Examples include:selective serotonin reuptake inhibitors (SSRIs), such asProzac (fluoxetine)andLexapro (escitalopram).
Anticoagulants
Some cold and allergy medications contain ingredients like aspirin or NSAIDs like ibuprofen.
These ingredients can increase the risk of bleeding when taken withanticoagulant medications(blood thinners), such asJantoven (warfarin)orXarelto (rivaroxaban).
Monoamine Oxidase Inhibitors (MAOIs)
WhenMAOIsare combined with decongestants, there is a risk of ahypertensive crisis, which can be life-threatening.
This interaction risk exists even if you took an MAOI in the past two weeks.
Examples of MAOIs include the antidepressant Marplan (isocarboxazid) and the antibioticZyvox (linezolid).
Opioids
Combining sedating antihistamines like Benadryl with prescription pain medications can lead to severe sedation and respiratory depression.
Examples ofopioid analgesicsinclude:Tylenol 3 (acetaminophen-codeine),morphine, andoxycodone.
Many other prescription medications may interact with cold or allergy medications.
To be safe, always read the product’s labeled warnings and consult a healthcare professional or pharmacist before taking OTC cold or sinus medications, especially if you’re taking prescription medications.
Summary
Sinusitis commonly affects 1 in 8 people in the United States each year. It often results from infections that trigger uncomfortable symptoms like congestion, facial pain, and headaches.
The good news is that antibiotics are not always necessary, and current guidelines recommend a symptom-focused approach to managing mild sinus infections.
If your symptoms worsen or do not improve while taking OTC medications for relief, or if you experience persistent fever, contact a healthcare provider.
They can help identify the cause of your symptoms and determine if antibiotics, such as Augmentin, or other prescription medications would be beneficial.
Frequently Asked QuestionsGenerally, oral OTC decongestants should be stored in a safe, dry place and kept at room temperature (68–77 F) away from children or pets.Furthermore, avoid storing your OTC decongestant in a place susceptible to high moisture levels, such as a bathroom.The safety of decongestants may vary depending on the type of medication you use, along with how far along you are in pregnancy or how commonly you breastfeed your child. For example, phenylephrine is generally not recommended during the first 13 weeks of pregnancy.Therefore, consult your healthcare provider before proceeding with an OTC decongestant.
Generally, oral OTC decongestants should be stored in a safe, dry place and kept at room temperature (68–77 F) away from children or pets.Furthermore, avoid storing your OTC decongestant in a place susceptible to high moisture levels, such as a bathroom.
Generally, oral OTC decongestants should be stored in a safe, dry place and kept at room temperature (68–77 F) away from children or pets.
Furthermore, avoid storing your OTC decongestant in a place susceptible to high moisture levels, such as a bathroom.
The safety of decongestants may vary depending on the type of medication you use, along with how far along you are in pregnancy or how commonly you breastfeed your child. For example, phenylephrine is generally not recommended during the first 13 weeks of pregnancy.Therefore, consult your healthcare provider before proceeding with an OTC decongestant.
The safety of decongestants may vary depending on the type of medication you use, along with how far along you are in pregnancy or how commonly you breastfeed your child. For example, phenylephrine is generally not recommended during the first 13 weeks of pregnancy.
Therefore, consult your healthcare provider before proceeding with an OTC decongestant.
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.FastStats - sinus conditions.Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al.Clinical practice guideline (update): adult sinusitis.Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39. doi:10.1177/0194599815572097MedlinePlus.Sinusitis.Patel GB, Kern RC, Bernstein JA, Hae-Sim P, Peters AT.Current and future treatments of rhinitis and sinusitis.J Allergy Clin Immunol Pract. 2020;8(5):1522-1531. doi:10.1016/j.jaip.2020.01.031Głowacka K, Wiela-Hojeńska A.Pseudoephedrine-benefits and risks.Int J Mol Sci.2021;22(10):5146. doi:10.3390/ijms22105146National Health Service.Decongestants.DailyMed.Label: Afrin Allergy Sinus Nasal- oxymetazoline hydrochloride spray.DailyMed.Label: Sudafed PE Head Congestion Plus Flu Severe- acetaminophen, dextromethorphan hydrobromide, guaifenesin, and phenylephrine hydrochloride tablet, film coated.Food and Drug Administration.FDA clarifies results of recent advisory committee meeting on oral phenylephrine.MedlinePlus.Antihistamines for allergies.Wallace DV, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM.Pharmacologic treatment of seasonal allergic rhinitis: synopsis of guidance from the 2017 joint task force on practice parameters.Ann Intern Med. 2017;167(12):876-881. doi:10.7326/M17-2203Food and Drug Administration.Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations.DailyMed.Label: Childrens' Benadryl Allergy- diphenhydramine hydrochloride solution.DailyMed.Label: Children Claritin Allergy- loratadine solution.DailyMed.Label: Children’s' Zyrtec Allergy- cetirizine hydrochloride syrup.Miligkos M, Dakoutrou M, Statha E, et al.Newer-generation antihistamines and the risk of adverse events in children: A systematic review.Pediatr Allergy Immunol. 2021;32(7):1533-1558. doi:10.1111/pai.13522Food and Drug Administration.Drug interactions: what you should know.
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.FastStats - sinus conditions.Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al.Clinical practice guideline (update): adult sinusitis.Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39. doi:10.1177/0194599815572097MedlinePlus.Sinusitis.Patel GB, Kern RC, Bernstein JA, Hae-Sim P, Peters AT.Current and future treatments of rhinitis and sinusitis.J Allergy Clin Immunol Pract. 2020;8(5):1522-1531. doi:10.1016/j.jaip.2020.01.031Głowacka K, Wiela-Hojeńska A.Pseudoephedrine-benefits and risks.Int J Mol Sci.2021;22(10):5146. doi:10.3390/ijms22105146National Health Service.Decongestants.DailyMed.Label: Afrin Allergy Sinus Nasal- oxymetazoline hydrochloride spray.DailyMed.Label: Sudafed PE Head Congestion Plus Flu Severe- acetaminophen, dextromethorphan hydrobromide, guaifenesin, and phenylephrine hydrochloride tablet, film coated.Food and Drug Administration.FDA clarifies results of recent advisory committee meeting on oral phenylephrine.MedlinePlus.Antihistamines for allergies.Wallace DV, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM.Pharmacologic treatment of seasonal allergic rhinitis: synopsis of guidance from the 2017 joint task force on practice parameters.Ann Intern Med. 2017;167(12):876-881. doi:10.7326/M17-2203Food and Drug Administration.Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations.DailyMed.Label: Childrens' Benadryl Allergy- diphenhydramine hydrochloride solution.DailyMed.Label: Children Claritin Allergy- loratadine solution.DailyMed.Label: Children’s' Zyrtec Allergy- cetirizine hydrochloride syrup.Miligkos M, Dakoutrou M, Statha E, et al.Newer-generation antihistamines and the risk of adverse events in children: A systematic review.Pediatr Allergy Immunol. 2021;32(7):1533-1558. doi:10.1111/pai.13522Food and Drug Administration.Drug interactions: what you should know.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.FastStats - sinus conditions.Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al.Clinical practice guideline (update): adult sinusitis.Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39. doi:10.1177/0194599815572097MedlinePlus.Sinusitis.Patel GB, Kern RC, Bernstein JA, Hae-Sim P, Peters AT.Current and future treatments of rhinitis and sinusitis.J Allergy Clin Immunol Pract. 2020;8(5):1522-1531. doi:10.1016/j.jaip.2020.01.031Głowacka K, Wiela-Hojeńska A.Pseudoephedrine-benefits and risks.Int J Mol Sci.2021;22(10):5146. doi:10.3390/ijms22105146National Health Service.Decongestants.DailyMed.Label: Afrin Allergy Sinus Nasal- oxymetazoline hydrochloride spray.DailyMed.Label: Sudafed PE Head Congestion Plus Flu Severe- acetaminophen, dextromethorphan hydrobromide, guaifenesin, and phenylephrine hydrochloride tablet, film coated.Food and Drug Administration.FDA clarifies results of recent advisory committee meeting on oral phenylephrine.MedlinePlus.Antihistamines for allergies.Wallace DV, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM.Pharmacologic treatment of seasonal allergic rhinitis: synopsis of guidance from the 2017 joint task force on practice parameters.Ann Intern Med. 2017;167(12):876-881. doi:10.7326/M17-2203Food and Drug Administration.Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations.DailyMed.Label: Childrens' Benadryl Allergy- diphenhydramine hydrochloride solution.DailyMed.Label: Children Claritin Allergy- loratadine solution.DailyMed.Label: Children’s' Zyrtec Allergy- cetirizine hydrochloride syrup.Miligkos M, Dakoutrou M, Statha E, et al.Newer-generation antihistamines and the risk of adverse events in children: A systematic review.Pediatr Allergy Immunol. 2021;32(7):1533-1558. doi:10.1111/pai.13522Food and Drug Administration.Drug interactions: what you should know.
Centers for Disease Control and Prevention.FastStats - sinus conditions.
Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al.Clinical practice guideline (update): adult sinusitis.Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39. doi:10.1177/0194599815572097
MedlinePlus.Sinusitis.
Patel GB, Kern RC, Bernstein JA, Hae-Sim P, Peters AT.Current and future treatments of rhinitis and sinusitis.J Allergy Clin Immunol Pract. 2020;8(5):1522-1531. doi:10.1016/j.jaip.2020.01.031
Głowacka K, Wiela-Hojeńska A.Pseudoephedrine-benefits and risks.Int J Mol Sci.2021;22(10):5146. doi:10.3390/ijms22105146
National Health Service.Decongestants.
DailyMed.Label: Afrin Allergy Sinus Nasal- oxymetazoline hydrochloride spray.
DailyMed.Label: Sudafed PE Head Congestion Plus Flu Severe- acetaminophen, dextromethorphan hydrobromide, guaifenesin, and phenylephrine hydrochloride tablet, film coated.
Food and Drug Administration.FDA clarifies results of recent advisory committee meeting on oral phenylephrine.
MedlinePlus.Antihistamines for allergies.
Wallace DV, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM.Pharmacologic treatment of seasonal allergic rhinitis: synopsis of guidance from the 2017 joint task force on practice parameters.Ann Intern Med. 2017;167(12):876-881. doi:10.7326/M17-2203
Food and Drug Administration.Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations.
DailyMed.Label: Childrens' Benadryl Allergy- diphenhydramine hydrochloride solution.
DailyMed.Label: Children Claritin Allergy- loratadine solution.
DailyMed.Label: Children’s' Zyrtec Allergy- cetirizine hydrochloride syrup.
Miligkos M, Dakoutrou M, Statha E, et al.Newer-generation antihistamines and the risk of adverse events in children: A systematic review.Pediatr Allergy Immunol. 2021;32(7):1533-1558. doi:10.1111/pai.13522
Food and Drug Administration.Drug interactions: what you should know.
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