Decongestives

Decongestives are drugs that have a decongestant effect (on the rhino-sinusoidal mucous membranes) and are used to support the treatment of infectious, post-infectious and allergic diseases of the rhino-sinusoidal mucous membranes. They reduce the symptom of nasal obstruction, which is perceived by patients as particularly annoying.

Decongestives do not represent a uniform group of active ingredients. Their therapeutic aim is to reduce the swelling of the rhino-sinusoidal mucosal area.

Decongestives are mainly used locally, but can also be administered orally.

Sympathomimetics: Sympathomimetics stimulate sympathetic alpha1 and alpha2 receptors and thus cause a rapid vasoconstriction of the mucosal capacity vessels with swelling of the nasal mucosa. Alpha-sympathomimetics are very often used topically in nasal sprays for the treatment of nasal mucosal swelling in allergic (and chronic) rhinitis. They are particularly suitable during the initial phase of treatment until, for example, glucocorticoid treatment is sufficiently effective. The alpha-sympathomimetics include e.g. tramazolin, oxymetazolin, xylometazolin.

Systemically effective alpha-sympathomimetics are: pseudoephedrine, phenylephrine, ephedrine, phenylpropanolamine. Combinations of alpha-sympathomimetics and non-steroidal anti-inflammatory drugs (NSA) (e.g. paracetamol/ibuprofen/ASS and alpha-sympathomimetics) have been shown to have synergistic effects on cold symptoms in randomized clinical trials. All sympathomimetics have dose-dependent cardiovascular side effects. Pseudoephedrine appears to have a comparatively favourable safety profile.

Glucocortic steroids: The other important group of active ingredients in decongestants are corticosteroids. Dexamethasone, beclomethasone dipropionate, flunisolide, budesonide, triamcinolone acetonide, momethasone furoate, fluticasone propionate, fluticasone furoate are available for nasal application. The modern glucocorticoids used in local therapy (in particular the C6/C9-halogenated glucocorticosteroids) are characterized by a high lipophilicity, by a pronounced tissue binding with high receptor affinity. This is usually expressed as receptor affinity (RRA) with reference to dexamethasone (RRA=100). The modern nasal glucocorticosteroids have a 10-30 times more potent effect than dexamethasone.

Phytotherapeutic decongestives: Phytotherapeutic decongestives include extracts of myrtol/cineol, pelargonii sidoidis radix, various combinations of gentian root, primrose flowers, sambuci flos (elderflower), verbena, bromelain.

Non-assigned decongestives: Other representatives of the decongestive group cannot be assigned to a specific active ingredient group. These include retinol, ipratropium bromide, hyaluronic acid and hypromellose.

The main field of application of decongestives is acute, recurrent acute and chronic rhinosinusitis as well as acute and chronic allergic rhinosinusitis.