Decongestants used to treat symptoms of the common cold are largely ineffective and should mostly be avoided, a new study says.
Researchers say the minor relief offered by decongestants is outweighed by the risks and side effects associated with these drugs.
This is especially true for children, the researchers say in a study published in the journal BMJ.
Decongestants and combination drugs that include decongestants can cause drowsiness, upset stomach, headaches, insomnia, and — if given to children under age 2 — serious complications, such as convulsions and rapid heart rate.
The study’s researchers, led by Dr. Mieke van Driel, head of the primary care clinical unit at the University of Queensland in Australia, advise parents against giving decongestants to children under age 6 and urge caution when administering the drugs to children under age 12.
“Most countries, such as the U.S. and Australia… recommend that in children aged 6 to 11 years, decongestants should only be used if advised by a physician,” van Driel said. “Older children (12 and up) have been included in studies with adults and haven’t been analyzed separately, so they are considered as adults for these products.”
Dr. Leonard Reeves, a member of the board of the American Academy of Family Physicians and an associate dean at the Medical College of Georgia, goes a step further.
“Under 12, I would not advise it at all,” the family physician told Healthline.
“We don’t really know why these drugs don’t work in children,” van Driel noted. “We only have a few small studies in children. But on the other hand, given that the effect in adults is small, we are not expecting that larger studies in children will change the conclusions.”
The common cold is a viral infection, usually involving rhinovirus.
Typical symptoms, such as runny nose, congestion, and fever, are actually the body’s immune response to the infection and not caused by the virus itself, says Reeves.
“When you have a cold, your body tries to fight the viruses where they enter the body, usually the nose and upper airways,” van Driel explained. “This inflammatory response causes the membranes of the nose and blood vessels in the nose to swell and produce discharge.”
The idea is to surround the virus with mucus that can then be expelled, Reeves adds.
Fever is the body’s way of raising temperatures to a level where the virus has more difficulty reproducing.
Reeves says that while taking pain medication to reduce cold-related headaches or a high fever is acceptable, it’s generally better to let the fever fight the virus.
Van Driel and colleagues looked at studies involving a wide variety of medications and folk remedies used to treat the common cold, including drugs, steam inhalation, echinacea, vapor rub, eucalyptus oil, and increased fluid intake.
Little evidence was found that any were effective in treating cold symptoms, according to the recent study.
Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil) and aspirin were found to provide pain relief, however.
“If parents are concerned about their child’s comfort, saline nasal irrigations or drops can be used safely,” van Driel and colleagues wrote.
For young children, Reeves recommends saline sprays sold under the brand names Ocean and Ayr. For older people, he recommends using a neti pot to loosen mucus and an old-fashioned bulb syringe to extract mucus.
“It won’t hurt anything” and might help, Reeves says.
If congestion moves to the chest, expectorants can help children cough up excess mucus, which can also provide some symptom relief, Reeves says.
Despite warning labels on decongestants, “Parents may not be aware that these drugs — and especially decongestants and combination products with decongestants — can be harmful in young children,” van Driel said.
She notes that parents may be lulled into a false sense of security about the safety of over-the-counter drugs in particular.
“Giving the child more than the recommended daily dose can increase the risk of adverse effects,” van Driel added.
Plus, Reeves said, “The symptoms of a cold are localized, so why use a systemic drug like decongestants?”
Instead, doctors and parents should simply tell children that symptoms of a common cold, while annoying, will pass naturally in a few days, the study concluded.
“Based on the currently available evidence, reassurance that symptoms are self-limiting is the best you can offer patients, although short-term use of decongestants in adults can provide some relief from a blocked nose,” according to the research review.
“The common cold has plagued mankind forever and will continue to do so. There’s no way to prevent it, and it’s hard to treat,” Reeves said.
“As the old saying goes, if you don’t do anything to treat a cold, it will go away in seven days. If you do try to treat it, it will take a week,” Reeves said with a laugh.