Uncomfortable and disruptive, many patients turn to OTC medications for relief from nasal congestion. As a pharmacist, it is essential to have a comprehensive understanding of both nasal congestion and possible treatment options like phenylephrine to provide accurate information and guidance to patients seeking relief. 

NASAL CONGESTION: CAUSES AND SYMPTOMS 

Nasal congestion occurs when the blood vessels in the nasal passages become swollen and inflamed, leading to a blocked airflow. This can result in difficulty breathing through the nose, a feeling of pressure or fullness, and an impaired sense of smell. Common causes of nasal congestion include: 

• Viral infections: The common cold and flu viruses can cause inflammation of the nasal passages, leading to congestion. 
• Allergies: Allergic reactions to pollen, pet dander, dust mites, or other allergens can trigger nasal congestion. 
• Sinusitis: Inflammation of the sinuses due to infection or other factors can lead to congestion. 
• Environmental irritants: Exposure to smoke, pollution, or strong odours can irritate the nasal passages and cause congestion. 

PHENYLEPHRINE: MECHANISM OF ACTION AND USE 

A nasal decongestant that belongs to the class of medications known as alpha-adrenergic agonists, phenylephrine works by constricting the blood vessels in the nasal passages, reducing blood flow to the inflamed area and relieving congestion. When administered as a nasal spray or drops, phenylephrine can provide rapid relief from nasal congestion. 

Phenylephrine is available in various formulations, including nasal sprays, drops, and oral tablets. It is important to note that while phenylephrine can be effective in relieving congestion, its use should be limited to a short duration (3-5 days). Prolonged use can lead to rebound congestion, where the nasal passages become even more congested once the medication is discontinued. 

GUIDELINES FOR PHARMACISTS 

As a pharmacist, your role in guiding patients seeking relief from nasal congestion is vital. Here are some key guidelines to follow: 

• Assessment and counselling: When a patient approaches you with nasal congestion, conduct a thorough assessment to determine the underlying cause. Inquire about allergies, recent illnesses, and other relevant medical history. Provide education on the importance of identifying and managing triggers, such as allergens. 
• Patient education: Explain how phenylephrine works and its potential benefits in relieving nasal congestion. Emphasise the importance of proper usage, including following dosing instructions and duration guidelines. Warn against prolonged use to prevent rebound congestion. 
• Alternative options: Inform patients about alternative treatments, such as saline nasal sprays, antihistamines, and steam inhalation. 
• Drug interactions and precautions: Advise patients to inform you about any existing medical conditions, medications, or supplements they are taking. Phenylephrine may interact with certain medications, and some individuals, such as those with cardiovascular issues, should use phenylephrine cautiously or avoid it altogether. 
• Follow-up: Encourage patients to return for a follow-up if their symptoms persist or worsen. Evaluate the effectiveness of the treatment and adjust recommendations accordingly. 

REFERENCES: 

• Richards E, Lopez MJ, Maani CV. Phenylephrine. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534801/ 
• https://www.drugs.com/tips/phenylephrine-patient-tips 
• https://www.nebraskamed.com/ear-nose-throat/will-nasal-spray-relieve-my-allergies-runny-nose-congestion#:~:text=Saline%20spray%20%E2%80%93%20Saline%20nasal%20sprays,seasonal%20allergies%20or%20other%20conditions. 
• https://www.everydayhealth.com/ear-nose-throat/nasal-sprays.aspx